Individual
DR. MICHAEL JAMES LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1110 N MAIN ST, EDGERTON, WI 53534
(608) 884-3314
(608) 884-4923
Mailing address
1110 N MAIN ST, EDGERTON, WI 53534
(608) 884-3314
(608) 884-4923
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1749
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38514300
—
WI
Enumeration date
07/28/2006
Last updated
07/08/2007
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