Provider Demographics
NPI:1265277362
Name:LANGLEY, COURTNEY (OD)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:LANGLEY
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 1:5745 N US HIGHWAY 231
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IN
Mailing Address - Zip Code:47460-6673
Mailing Address - Country:US
Mailing Address - Phone:918-935-8135
Mailing Address - Fax:
Practice Address - Street 1:3013 S US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-3791
Practice Address - Country:US
Practice Address - Phone:812-234-4434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004521B152W00000X
IN18004521A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist