Basic Information
| Provider Information | |||||||||
| NPI: | 1639182561 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LANGE EYE CARE & ASSOCIATES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3101 SW COLLEGE RD | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344748459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522371566 | ||||||||
| FaxNumber: | 3522370561 | ||||||||
| Practice Location | |||||||||
| Address1: | 3101 SW COLLEGE RD | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344748459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522371566 | ||||||||
| FaxNumber: | 3522370561 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 10/03/2013 | ||||||||
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| AuthorizedOfficialLastName: | LANGE | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3522371566 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OP2631 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 620668900 | 05 | FL | MEDICAID | 078976301 | 05 | FL | MEDICAID |