Healthcare Provider Details

I. General information

NPI: 1487912200
Provider Name (Legal Business Name): DR. JEFF M. LONG ENTERPRISES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7374 S OLYMPIA AVE
TULSA OK
74132-1849
US

IV. Provider business mailing address

7374 S OLYMPIA AVE
TULSA OK
74132-1849
US

V. Phone/Fax

Practice location:
  • Phone: 918-794-2020
  • Fax: 918-794-2720
Mailing address:
  • Phone: 918-794-2020
  • Fax: 918-794-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY MICHAEL LONG
Title or Position: PRESIDENT/OWNER
Credential: O.D.
Phone: 918-794-2020