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NPI Code Detail

MEDICARE: DR. MARY BLAIR LONG O.D.

MEDICARE: DR. MARY BLAIR LONG O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOEG002240PA

General Provider Information

NPI Number : 1669604641
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY BLAIR LONG O.D.
Provider Business Mailing Address
First Line : 900 COMMERCE BLVD
Second Line : VISION CENTER #1884 NEXT TO WALMART
City : DICKSON CITY
State : PA
Zip : 18519-1767
Country : US
Telephone Number : 570-383-9358
Fax Number : 570-383-1205
Provider Business Practice Location Address
First Line : 900 COMMERCE BLVD
Second Line : VISION CENTER #1884 NEXT TO WALMART
City : DICKSON CITY
State : PA
Zip : 18519-1767
Country : US
Telephone Number : 570-383-9358
Fax Number : 570-383-1205
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2009
Last Update Date : 04/24/2013

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Directions to “ DR. MARY BLAIR LONG O.D.” Practice Location

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