Provider Demographics
NPI:1659363281
Name:LANGE, JOHN E (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:LANGE
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:PO BOX 2020
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-2020
Mailing Address - Country:US
Mailing Address - Phone:360-683-7269
Mailing Address - Fax:360-683-7499
Practice Address - Street 1:321 N SEQUIM AVE # A
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3457
Practice Address - Country:US
Practice Address - Phone:360-683-7269
Practice Address - Fax:360-683-7499
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1293TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2066306Medicaid
WATO2534Medicare UPIN
WAP00629134Medicare PIN
WA0279980001Medicare NSC
WA2066306Medicaid