Provider Demographics
NPI:1871931006
Name:LANGEVIN EYE CENTER P.A.
Entity type:Organization
Organization Name:LANGEVIN EYE CENTER P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:LANGEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-492-2136
Mailing Address - Street 1:65 WAL MART DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-6784
Mailing Address - Country:US
Mailing Address - Phone:870-492-2136
Mailing Address - Fax:870-492-7099
Practice Address - Street 1:65 WAL MART DR
Practice Address - Street 2:SUITE 8
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-6784
Practice Address - Country:US
Practice Address - Phone:870-492-2208
Practice Address - Fax:870-492-7099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2264152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty