Provider Demographics
NPI:1588006100
Name:RICHARD G. LANGELLOTTI, OD
Entity Type:Organization
Organization Name:RICHARD G. LANGELLOTTI, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:LANGELLOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-924-6147
Mailing Address - Street 1:2310 FINLEY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4047
Mailing Address - Country:US
Mailing Address - Phone:919-924-6147
Mailing Address - Fax:252-822-0033
Practice Address - Street 1:1205 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:NC
Practice Address - Zip Code:27856-1814
Practice Address - Country:US
Practice Address - Phone:252-291-3939
Practice Address - Fax:252-822-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1667152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty