Provider Demographics
NPI:1720022932
Name:LANG, TAMI R (OD)
Entity Type:Individual
Prefix:DR
First Name:TAMI
Middle Name:R
Last Name:LANG
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:5230 E. VILLA RITA DRIVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4726
Mailing Address - Country:US
Mailing Address - Phone:602-996-9906
Mailing Address - Fax:602-996-0943
Practice Address - Street 1:4324 E CACTUS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7636
Practice Address - Country:US
Practice Address - Phone:602-996-9906
Practice Address - Fax:602-996-0943
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ688152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU02050Medicare UPIN