Organization
LONGE OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY KENSILL (OWNER)
(260) 484-2691
Entity
Organization
Contact information
Practice address
7625 SOUTHTOWN CROSSING, FORT WAYNE, IN 46816-2506
(260) 447-3583
(260) 441-8276
Mailing address
7625 SOUTHTOWN CROSSING, FORT WAYNE, IN 46816-2506
(260) 447-3583
(260) 441-8276
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100173460B
—
IN
Enumeration date
10/24/2006
Last updated
04/22/2009
Update your record
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