Provider Demographics
NPI:1306639331
Name:ZANGENBERG, JACOB MATTHEW (OD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:MATTHEW
Last Name:ZANGENBERG
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 1:69 HARDIN LN
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-8971
Mailing Address - Country:US
Mailing Address - Phone:406-600-9975
Mailing Address - Fax:
Practice Address - Street 1:3820 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3233
Practice Address - Country:US
Practice Address - Phone:406-587-1245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-23
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOPT-OPT-LIC-5588152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty