Amanda L Lang, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

004110 Issued in MI

Practice address

5959 Lawndale St
Ludington, MI 49431-2921

Phone

(231) 845-6261

Fax

(231) 843-9171

NPI assigned

Jan 25, 2006

Last updated

Nov 2, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Ohio State University - College of Optometry, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tri-Cities Community HealthGroup PAC ID 4183517469, 25 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amanda.lang.1@21034.direct.athenahealth.com

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Tri-Cities Community Health

  • Federally Qualified Health Center (FQHC)
  • Richland, WA
  • NPI 1053771998

  W-2 Managing Employee

  CMS ownership
• Tri-Cities Community Health

  • Federally Qualified Health Center (FQHC)
  • Pasco, WA
  • NPI 1215588371

  W-2 Managing Employee

  CMS ownership
• Tri-Cities Community Health

  • Federally Qualified Health Center (FQHC)
  • Pasco, WA
  • NPI 1225145105

  Corporate Director, W-2 Managing Employee

  CMS ownership
• Tri-Cities Community Health

  • Federally Qualified Health Center (FQHC)
  • Richland, WA
  • NPI 1750825444

  Corporate Director

  CMS ownership
• Tri-Cities Community Health

  • Federally Qualified Health Center (FQHC)
  • Kennewick, WA
  • NPI 1861698987

  Corporate Director, W-2 Managing Employee

  CMS ownership
• Tri-Cities Community Health

  • Federally Qualified Health Center (FQHC)
  • Pasco, WA
  • NPI 1861896631

  W-2 Managing Employee

  CMS ownership

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tri-Cities Community Health

  • Federally Qualified Health Center (FQHC)
  • Kennewick, WA
  • NPI 1861698987
  Medicare reassignment Care Compare group NPD
• Tri-Cities Community Health

  dba TCCH Pharmacy-Richland

  • Community/Retail Pharmacy
  • Richland, WA
  • NPI 1457868556
  NPD
• Tri Cities Community Health

  • Federally Qualified Health Center (FQHC)
  • Pasco, WA
  • NPI 1659995504
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320192000000",
    "number": "1295705846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5959 LAWNDALE ST",
            "city": "LUDINGTON",
            "state": "MI",
            "postal_code": "494312921",
            "telephone_number": "231-845-6261",
            "fax_number": "231-843-9171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5959 LAWNDALE ST",
            "city": "LUDINGTON",
            "state": "MI",
            "postal_code": "494312921",
            "telephone_number": "231-845-6261",
            "fax_number": "231-843-9171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANG",
        "first_name": "AMANDA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-25",
        "last_updated": "2011-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "004110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4620819",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4620828",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4921634",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MICHIGAN",
            "identifier": "900F410030",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00138760",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lakeshore Spine and Pain PC (Accessible Urgent Care)
• Lakeshore Vein &Laser Clinic PLLC
• Lakewinds Dental Centre
• Britney Laman, LMSW
• Jaime Lynn Lamendola, RN
• Rebecca Sue Lange, LMSW
• Keith David Langlois, MD
• John Michael Large, O.D.
• Monica Largent, SLP-CCC
• Cheryl Lynn Larson, D.D.S.

• Optometrist in Ludington, MI
• Providers in Ludington, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.