Provider Demographics
NPI:1639156144
Name:LANGFORD, DAWN MICHELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:MICHELLE
Last Name:LANGFORD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:MORRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 5076
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5076
Mailing Address - Country:US
Mailing Address - Phone:308-384-0220
Mailing Address - Fax:308-382-1650
Practice Address - Street 1:420 N DIERS AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4979
Practice Address - Country:US
Practice Address - Phone:308-384-0220
Practice Address - Fax:308-382-1650
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1110152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
39717OtherBLUE CROSS BLUE SHIELD
10431OtherMIDLANDS CHOICE
U70338Medicare UPIN
273175Medicare ID - Type Unspecified