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General NPI Number Information
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NPI Number | 1306639331
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Entity Type | Individual
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Provider Name | JACOB MATTHEW ZANGENBERG OD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 3820 N 27TH AVE
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City | BOZEMAN
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State | MT
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Zip | 59718-3233
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Country | US
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Telephone | 406-587-1245
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Fax |
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Provider Business Mailing Address
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Address Line | 69 HARDIN LN
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City | BOZEMAN
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State | MT
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Zip | 59718-8971
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Country | US
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Telephone | 406-600-9975
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT-OPT-LIC-5588
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License Number State | MT
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