Individual
LAURA JILL LONGNECKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1316 S STATE ST, JERSEYVILLE, IL 62052-3617
(618) 498-7244
Mailing address
RR 1 BOX 83D, HARDIN, IL 62047-9609
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046.010526
IL
Other
Enumeration date
11/16/2011
Last updated
11/16/2011
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