Provider Demographics
NPI:1023354610
Name:LANG, LAURA (OD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:LANG
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 1:15855 W NATIONAL AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-5159
Mailing Address - Country:US
Mailing Address - Phone:262-923-7073
Mailing Address - Fax:
Practice Address - Street 1:15855 W NATIONAL AVE
Practice Address - Street 2:STE 101
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151
Practice Address - Country:US
Practice Address - Phone:262-923-7073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-31
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3267-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist