Provider Demographics
NPI:1639182561
Name:LANGE EYE CARE & ASSOCIATES PA
Entity Type:Organization
Organization Name:LANGE EYE CARE & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:352-753-4014
Mailing Address - Street 1:3101 SW COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-8459
Mailing Address - Country:US
Mailing Address - Phone:352-237-1566
Mailing Address - Fax:352-237-0561
Practice Address - Street 1:11834 COUNTY ROAD 101
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-9340
Practice Address - Country:US
Practice Address - Phone:352-753-4014
Practice Address - Fax:844-272-7134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP2631152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620668900Medicaid
FL078976301Medicaid
FL078976301Medicaid
FL21385Medicare PIN