Organization
LONGE OPTICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARTHA C DAVENPORT (OFFICE MANAGER)
(260) 347-1128
Entity
Organization
Contact information
Practice address
3409 N ANTHONY BLVD, FT WAYNE, IN 46805
(260) 484-2691
Mailing address
3409 N ANTHONY BLVD, FT. WAYNE, IN 46805
(260) 484-2691
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100173460
—
IN
05
—
100173460E
—
IN
Enumeration date
05/18/2006
Last updated
01/28/2011
Update your record
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