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General NPI Number Information
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NPI Number | 1568602019
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Entity Type | Organization
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Legal Business Name | LONG EYECARE & VISION SERVICES, LLC
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Dates
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Enumeration Date | 02/24/2009
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Last Update Date | 04/18/2014
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Provider Practice Location Address
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Address Line | 1521 GUNTER AVENUE
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City | GUNTERSVILLE
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State | AL
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Zip | 35976
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Country | US
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Telephone | 256-582-3146
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Fax | 256-582-4851
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Provider Business Mailing Address
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Address Line | 1521 GUNTER AVENUE
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City | GUNTERSVILLE
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State | AL
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Zip | 35976
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Country | US
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Telephone | 256-582-3146
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Fax | 256-582-4851
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. COURTNEY LONG
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Credential |
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Telephone | 256-673-5140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | S369TA156
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License Number State | AL
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