Organization
LONG SIGHT, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JILDA EDEAN LONG O.D. (OPTOMETRIST/ OWNER)
(540) 875-8036
Entity
Organization
Contact information
Practice address
22 CAMPBELL AVE SE, ROANOKE, VA 24011-1404
(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
261Q00000X
Clinic/Center
0618001106
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009237674
—
VA
01
—
1700070083
RAILROAD MEDICARE GROUP NPI
VA
01
—
410047559
RAILROAD MEDICARE GROUP PTAN
VA
01
—
DO5547
RAILROAD MEDICARE GROUP PTAN
VA
Enumeration date
08/30/2007
Last updated
08/02/2019
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