Organization
JAMES A. LONG, II O.D. INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES A LONG II OD (OPTOMETRIST)
(260) 484-2720
Entity
Organization
Contact information
Practice address
1221 MEDICAL PARK DR, FORT WAYNE, IN 46825-5887
(260) 484-2720
(260) 471-3488
Mailing address
1221 MEDICAL PARK DR, FORT WAYNE, IN 46825-5887
(260) 448-4272
(260) 471-3488
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
18001507
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100280880A
—
IN
Enumeration date
08/27/2009
Last updated
08/27/2009
Update your record
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