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General NPI Number Information
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NPI Number | 1750978987
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Entity Type | Organization
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Legal Business Name | LONGNECKER OPTOMETRY LLC
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Dates
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Enumeration Date | 12/22/2020
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 324 A FIFTH ST
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City | CARROLLTON
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State | IL
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Zip | 62016
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Country | US
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Telephone | 217-942-3300
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Fax | 217-942-3306
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Provider Business Mailing Address
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Address Line | 324 A FIFTH ST
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City | CARROLLTON
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State | IL
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Zip | 62016
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Country | US
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Telephone | 217-942-3300
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Fax | 217-942-3306
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | LAURA LONGNECKER
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Credential | OD
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Telephone | 217-942-3300
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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 |
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License Number State |
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