Provider Demographics
NPI:1659558609
Name:ANDY LANGSTON, OD, PA
Entity Type:Organization
Organization Name:ANDY LANGSTON, OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PH D, OD
Authorized Official - Phone:479-253-4040
Mailing Address - Street 1:NO 1 PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY ISLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72631-9221
Mailing Address - Country:US
Mailing Address - Phone:479-253-4040
Mailing Address - Fax:479-253-5636
Practice Address - Street 1:NO 1 PARK DR STE B
Practice Address - Street 2:
Practice Address - City:HOLIDAY ISLAND
Practice Address - State:AR
Practice Address - Zip Code:72631-9221
Practice Address - Country:US
Practice Address - Phone:479-253-4040
Practice Address - Fax:479-253-5636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2430152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARU38481Medicare UPIN
AR4571990001Medicare NSC