Individual
LANCE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1303 SUITE 108 US 127 SOUTH, FRANKFORT, KY 40601
(502) 875-3050
(502) 226-4261
Mailing address
1303 SUITE 108 US 127 SOUTH, FRANKFORT, KY 40601
(502) 875-3050
(502) 226-4261
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1460DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000351964
ANTHEM BCBS
KY
01
—
1460DT
OD LICENSE NUMBER
KY
05
—
77000149
—
KY
01
—
P00217662
RR MEDICARE
KY
Enumeration date
08/16/2005
Last updated
11/06/2020
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