Provider Demographics
NPI:1982802658
Name:LANGLE, KARINA VICTORIA (OD)
Entity Type:Individual
Prefix:DR
First Name:KARINA
Middle Name:VICTORIA
Last Name:LANGLE
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 1:3402 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-3339
Mailing Address - Country:US
Mailing Address - Phone:773-941-6519
Mailing Address - Fax:773-941-6539
Practice Address - Street 1:3402 W 111TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-3339
Practice Address - Country:US
Practice Address - Phone:773-941-6519
Practice Address - Fax:708-229-2233
Is Sole Proprietor?:No
Enumeration Date:2007-07-04
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009964152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009964Medicaid
IL5206710001Medicare NSC
ILK41121Medicare PIN