Organization
LONGE OPTICAL NORTH INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY R KENSILL (PRESIDENT)
(260) 484-2691
Entity
Organization
Contact information
Practice address
10240 COLDWATER RD, FORT WAYNE, IN 46825-2035
(260) 497-8626
(260) 484-8486
Mailing address
10240 COLDWATER RD., FORT WAYNE, IN 46825
(260) 484-2691
(260) 484-0616
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100173460F
—
IN
Enumeration date
09/23/2009
Last updated
10/07/2009
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