Provider Demographics
NPI:1811202716
Name:LANGFORD, MATTHEW (OD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:LANGFORD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3629 3RD AVE
Mailing Address - Street 2:#6
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4157
Mailing Address - Country:US
Mailing Address - Phone:209-761-9288
Mailing Address - Fax:
Practice Address - Street 1:3750 SPORTS ARENA BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5129
Practice Address - Country:US
Practice Address - Phone:619-224-2879
Practice Address - Fax:619-224-1311
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14030152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFK524ZOtherP-TAN
CA1811202716OtherNPI