Basic Information
| Provider Information | |||||||||
| NPI: | 1548329089 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KRISTEN LANGNER EYE CARE PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LANGNER EYE CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ROSELLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601722076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305290993 | ||||||||
| FaxNumber: | 6305291220 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ROSELLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601722076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305290993 | ||||||||
| FaxNumber: | 6305291220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 12/30/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LANGNER | ||||||||
| AuthorizedOfficialFirstName: | KRISTEN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6305290993 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 046008752 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.