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NPI Code Detail

MEDICARE: DR. JEFFREY MICHAEL LANG WIEBER O.D.

MEDICARE: DR. JEFFREY MICHAEL LANG WIEBER O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist3186MN

General Provider Information

NPI Number : 1255569364
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY MICHAEL LANG WIEBER O.D.
Provider Business Mailing Address
First Line : 261 E BROADWAY ST
Second Line : PO BOX 540
City : MONTICELLO
State : MN
Zip : 55362-9317
Country : US
Telephone Number : 763-295-5292
Fax Number : 763-271-4219
Provider Business Practice Location Address
First Line : 261 E BROADWAY ST
Second Line :
City : MONTICELLO
State : MN
Zip : 55362-9317
Country : US
Telephone Number : 763-295-5292
Fax Number : 763-271-4219
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2009
Last Update Date : 06/26/2009

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