Individual
DR. JACOB DANIEL LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2202 HWY 82 WEST, GREENWOOD, MS 38930-2706
(662) 609-6402
Mailing address
110 ACORN LN, BATESVILLE, MS 38606-2359
(662) 609-6402
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
887
MS
Other
Enumeration date
07/26/2013
Last updated
07/26/2013
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