Organization
LONGE OPTICAL- NORTH INC.
Active
Parent organization
LONGE OPTICAL- NORTH INC.
Other names
Longe Optical
Organization subpart
Yes
Provider details
NPI number
Legal business name
LONGE OPTICAL- NORTH INC.
Authorized official
MR. BRENT BAIR (STORE MANAGER)
(260) 432-8409
Entity
Organization
Contact information
Practice address
5721 COVENTRY LN, FORT WAYNE, IN 46804-7146
(260) 432-8409
(260) 432-8506
Mailing address
5721 COVENTRY LN, FORT WAYNE, IN 46804-7146
(260) 432-8409
(260) 432-8506
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100173460C
—
IN
Enumeration date
09/16/2009
Last updated
10/07/2009
Update your record
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