Individual
SUSAN LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1300 W I-40 FRONTAGE RD STE 322, GALLUP, NM 87301-3323
(505) 722-3030
(505) 722-0367
Mailing address
1300 W I-40 FRONTAGE RD STE 322, GALLUP, NM 87301-3323
(505) 722-3030
(505) 722-0367
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
03-037772-00-2
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
90481763
—
NM
Enumeration date
12/29/2006
Last updated
07/08/2007
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