Provider Demographics
NPI:1417007022
Name:LANG, ORNA AHOOBIM (OD)
Entity Type:Individual
Prefix:
First Name:ORNA
Middle Name:AHOOBIM
Last Name:LANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1158 MISSION DR
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4209
Mailing Address - Country:US
Mailing Address - Phone:714-966-2180
Mailing Address - Fax:
Practice Address - Street 1:457 LOS CERRITOS MALL
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5426
Practice Address - Country:US
Practice Address - Phone:562-809-2033
Practice Address - Fax:562-809-4113
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11559T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP11559Medicare ID - Type Unspecified
CAU90925Medicare UPIN