Provider Demographics
NPI:1487719423
Name:LANGEVIN VISION CLINIC
Entity type:Organization
Organization Name:LANGEVIN VISION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANGEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-425-8899
Mailing Address - Street 1:115 SOUTH COLLEGE STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653
Mailing Address - Country:US
Mailing Address - Phone:870-425-8899
Mailing Address - Fax:870-425-2544
Practice Address - Street 1:115 SOUTH COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653
Practice Address - Country:US
Practice Address - Phone:870-425-8899
Practice Address - Fax:870-425-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2264152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
49130Medicare ID - Type Unspecified
T20281Medicare UPIN