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Individual

PAUL T. LANG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
136 EAST GRAND RIVER AVE., FOWLERVILLE, MI 48813-1510
(517) 223-9988
(517) 223-9071
Mailing address
1005 CHARLEVOIX DR STE 100, GRAND LEDGE, MI 48837-8186
(517) 337-1668
(517) 622-1205

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003764
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
200000023735
PHP
01
900C848370
BCBSM
MI
Enumeration date
04/05/2006
Last updated
01/27/2020
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