Provider Demographics
NPI:1407337439
Name:LANG, MASON (OD)
Entity Type:Individual
Prefix:DR
First Name:MASON
Middle Name:
Last Name:LANG
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 1:500 PAWNEE PL
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-3306
Mailing Address - Country:US
Mailing Address - Phone:510-456-5848
Mailing Address - Fax:
Practice Address - Street 1:301 RANCH DRIVE
Practice Address - Street 2:OPTOMETRIST OFFICE
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035
Practice Address - Country:US
Practice Address - Phone:408-956-0731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008867152W00000X
CA34493TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist