Provider Demographics
NPI:1063030203
Name:LANGEL, JORDAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:LANGEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 W 58TH ST UNIT 7
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-6510
Mailing Address - Country:US
Mailing Address - Phone:712-540-5031
Mailing Address - Fax:
Practice Address - Street 1:2812 W 41ST ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4202
Practice Address - Country:US
Practice Address - Phone:605-338-3225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD763152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist