Provider Demographics
NPI:1447781190
Name:LANGDON, MARTIN (ABOC)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:LANGDON
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 KING RD
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1759
Mailing Address - Country:US
Mailing Address - Phone:610-644-3347
Mailing Address - Fax:
Practice Address - Street 1:520 KING RD
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1759
Practice Address - Country:US
Practice Address - Phone:610-644-3347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician