Individual
NYDIA JEANETTE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LDO
Contact information
Practice address
2050 W SPRING ST, MONROE, GA 30655-3164
(770) 267-1237
(770) 267-3079
Mailing address
2050 W SPRING ST, MONROE, GA 30655-3164
(770) 267-1237
(770) 267-3079
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
LDO002683
GA
Other
Enumeration date
03/05/2024
Last updated
03/05/2024
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