Individual
JILDA EDEAN LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
22 CAMPBELL AVE SE, ROANOKE, VA 24011
(540) 982-7890
(540) 982-7891
Mailing address
4251 TWIN MOUNTAIN DR, VINTON, VA 24179-1021
(540) 875-8036
(888) 840-8937
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618001106
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2119121
CIGNA
—
01
—
277658
ANTHEM
VA
01
—
542036583
UNITED HEALTH CARE
VA
05
—
9237674
—
VA
Enumeration date
06/14/2006
Last updated
08/02/2019
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