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:
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Other - Credentials:
Mailing Address - Street 1:314 N TAMIAMI TRL
Mailing Address - Street 2:SUITE 112
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-4839
Mailing Address - Country:US
Mailing Address - Phone:941-637-0202
Mailing Address - Fax:941-637-0425
Practice Address - Street 1:314 N TAMIAMI TRL
Practice Address - Street 2:SUITE 112
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4839
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:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2288152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL410031991OtherMEDICARE RAILROAD
FL0341776OtherCIGNA
FL078880500Medicaid
FL19062OtherBLUE CROSS BLUE SHIELD
FL2307923OtherAETNA
FL87726OtherUNITEDHEALTHCARE
FLK2572Medicare PIN
FL0721810001Medicare NSC
FL87726OtherUNITEDHEALTHCARE
FL19062OtherBLUE CROSS BLUE SHIELD