Provider Demographics
NPI:1346735198
Name:LANGER, HOLLY ROSE (OD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:ROSE
Last Name:LANGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1213 SAINT CROIX ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:WI
Mailing Address - Zip Code:54021-1041
Mailing Address - Country:US
Mailing Address - Phone:651-295-7427
Mailing Address - Fax:
Practice Address - Street 1:715 E 78TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-1397
Practice Address - Country:US
Practice Address - Phone:952-854-2262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3574152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist