Individual
JACOB R LANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2950 CURVE CREST BLVD W, STILLWATER, MN 55082-5085
(651) 275-3000
Mailing address
1719 TOWER DR W STE 100, STILLWATER, MN 55082-7512
(651) 439-3050
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2953
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163427500
—
MN
01
—
P00324834
RAILROAD MEDICARE
MN
Enumeration date
07/10/2006
Last updated
05/14/2020
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