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General NPI Number Information
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NPI Number | 1578788014
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Entity Type | Organization
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Legal Business Name | JAMES W LONG MD PC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 10/27/2007
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Provider Practice Location Address
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Address Line | 1020 LIBERTY ST SE
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City | SALEM
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State | OR
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Zip | 97302-4141
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Country | US
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Telephone | 503-581-7412
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Fax | 503-581-1095
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Provider Business Mailing Address
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Address Line | 1020 LIBERTY ST SE
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City | SALEM
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State | OR
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Zip | 97302-4141
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Country | US
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Telephone | 503-581-7412
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Fax | 503-581-1095
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. KAREN D WALLS
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Credential |
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Telephone | 503-581-7412
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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 | 1604AT
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3152ATI
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD26362
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | MD10954
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License Number State | OR
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Taxonomy #5
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD10954
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License Number State | OR
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