Provider Demographics
NPI:1295748291
Name:LANGE, MICHAEL P (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:LANGE
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 1:3101 SW COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-8459
Mailing Address - Country:US
Mailing Address - Phone:352-237-3768
Mailing Address - Fax:352-237-4595
Practice Address - Street 1:3101 SW COLLEGE RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-8459
Practice Address - Country:US
Practice Address - Phone:352-237-3768
Practice Address - Fax:352-237-4595
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP2631152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078976301Medicaid
FL078976301Medicaid
FL20423AMedicare ID - Type Unspecified