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Individual

ALISSA R LONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
1941 LIMESTONE RD STE 200, WILMINGTON, DE 19808-5400
(302) 998-2333
(302) 998-2982
Mailing address
1941 LIMESTONE RD STE 200, WILMINGTON, DE 19808-5400
(302) 998-2333
(302) 998-2982

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
I3-0001342
DE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11895550
CAQH ID
DE
01
1245251313
MEDICARE GROUP NPI
DE
01
1639326721
INDIVIDUAL NPI
DE
01
802115H16
MEDICARE GRP MEMBER PTAN
01
G00016
MEDICARE GRP PTAN
01
I3-0001342
DE STATE LICENSE
DE
01
P00947088
PALMETTO GBA RR MEDICARE PTAN
DE
Enumeration date
08/20/2008
Last updated
05/08/2024
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