Provider Demographics
NPI:1740400472
Name:LANGEVIN, MICHAEL A (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:LANGEVIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:65 WAL MART DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-6784
Mailing Address - Country:US
Mailing Address - Phone:870-492-2208
Mailing Address - Fax:870-492-7099
Practice Address - Street 1:65 WAL MART DR
Practice Address - Street 2:SUITE 8
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-6784
Practice Address - Country:US
Practice Address - Phone:870-492-2208
Practice Address - Fax:870-492-7099
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2015-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AR2264152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199849722Medicaid
AR199849722Medicaid