Provider Demographics
NPI:1841586260
Name:LANG, STEPHANIE ASHLEY (OD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ASHLEY
Last Name:LANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 BOYLSTON ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-2013
Mailing Address - Country:US
Mailing Address - Phone:814-368-3937
Mailing Address - Fax:814-368-4728
Practice Address - Street 1:109 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-2013
Practice Address - Country:US
Practice Address - Phone:814-368-3937
Practice Address - Fax:814-368-4728
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist