Provider Demographics
NPI:1841291051
Name:LANGE, RONALD HERBERT (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:HERBERT
Last Name:LANGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 DAMON ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3899
Mailing Address - Country:US
Mailing Address - Phone:715-834-8471
Mailing Address - Fax:715-834-0373
Practice Address - Street 1:2715 DAMON ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-2634
Practice Address - Country:US
Practice Address - Phone:715-834-8471
Practice Address - Fax:715-834-0373
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23994-020207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30617300Medicaid
WI180028278Medicare PIN
B54435Medicare UPIN
WI30617300Medicaid