Individual
ALISSA R LONG
Active
Individual
ALISSA R LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
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
Update your record
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