Individual
DR. REBECCA A. LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
6097 US HIGHWAY 6, PORTAGE, IN 46368-5215
(219) 763-1538
Mailing address
3303 CLAIRBORNE XING, VALPARAISO, IN 46385-2969
(219) 246-7807
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002310A
IN
152W00000X
Optometrist
18002310B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11887606
CAQH
IN
05
—
201034350
—
IN
Enumeration date
02/08/2007
Last updated
02/15/2017
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