Active NPI
Jeffrey Michael Lang Wieber, O.D.
- Optometrist
- Monticello, MN
National Provider Identifier
1255569364
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3186
- Practice address
- 261 E Broadway St
Monticello, MN 55362-9317 - Phone
- (763) 295-5292
- Fax
- (763) 271-4219
- NPI assigned
- Jun 26, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3186 | MN | Primary |
Addresses
Primary practice location
261 E Broadway St
Monticello, MN 55362-9317
Mailing address
261 E Broadway St
PO Box 540
Monticello, MN 55362-9317
Phone (763) 295-5292
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3186 | MN | MD | Nutrition Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245974400000",
"number": "1255569364",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "261 E BROADWAY ST",
"address_2": "PO BOX 540",
"city": "MONTICELLO",
"state": "MN",
"postal_code": "553629317",
"telephone_number": "763-295-5292",
"fax_number": "763-271-4219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "261 E BROADWAY ST",
"city": "MONTICELLO",
"state": "MN",
"postal_code": "553629317",
"telephone_number": "763-295-5292",
"fax_number": "763-271-4219"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIEBER",
"first_name": "JEFFREY",
"middle_name": "MICHAEL LANG",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-06-26",
"last_updated": "2009-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "3186",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monticello, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.