Individual
DR. BLAKE ELIZABETH LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
7706 WINCHESTER RD, 105, MEMPHIS, TN 38125
(901) 752-1551
(901) 752-1505
Mailing address
2547 MACKINNON DR, MEMPHIS, TN 38119-7903
(901) 258-2800
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3623
TN
Other
Enumeration date
07/14/2020
Last updated
07/14/2020
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