Provider Demographics
NPI:1952336794
Name:LANG, TODD BRENTLEY (OD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:BRENTLEY
Last Name:LANG
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 1:970 KINGS HWY UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33980-4213
Mailing Address - Country:US
Mailing Address - Phone:941-637-0202
Mailing Address - Fax:941-637-0425
Practice Address - Street 1:970 KINGS HWY UNIT 2
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33980-4213
Practice Address - Country:US
Practice Address - Phone:941-637-0202
Practice Address - Fax:941-637-0425
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1141152W00000X
FLOPC 2288152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL410031991OtherMEDICARE RAILROAD
FL19062OtherBLUE CROSS BLUE SHIELD
FL0341776OtherCIGNA
FL87726OtherUNITEDHEALTHCARE
FL078880500Medicaid
FL2307923OtherAETNA
FLK2572Medicare PIN
FL0721810001Medicare NSC
FL87726OtherUNITEDHEALTHCARE
FL19062OtherBLUE CROSS BLUE SHIELD