Organization
LONGE OPTICAL-NORTH INC,
Active
Parent organization
LONGE OPTICAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
LONGE OPTICAL
Authorized official
MRS. TRICIA ANN MAYES (MANAGER)
(260) 486-4477
Entity
Organization
Contact information
Practice address
4534 MAPLECREST RD, FORT WAYNE, IN 46835-3970
(260) 486-4477
(260) 486-4533
Mailing address
4534 MAPLECREST RD, FORT WAYNE, IN 46835-3970
(260) 486-4477
(260) 486-4533
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100173460G
—
IN
Enumeration date
09/16/2009
Last updated
10/07/2009
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