Provider Demographics
NPI:1265446751
Name:LANGFORD, JEFFERSON ROBERT (OD)
Entity type:Individual
Prefix:
First Name:JEFFERSON
Middle Name:ROBERT
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 1:2110 E FLAMINGO RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5190
Mailing Address - Country:US
Mailing Address - Phone:702-733-2020
Mailing Address - Fax:702-794-2797
Practice Address - Street 1:2110 E FLAMINGO RD
Practice Address - Street 2:SUITE 210
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5190
Practice Address - Country:US
Practice Address - Phone:702-733-2020
Practice Address - Fax:702-794-2797
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV554152W00000X
UT9848901-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP00370806OtherRAILROAD MEDICARE
NV100511123Medicaid