MEDICARE: MR. CHRISTOPHER C 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
1	152W00000X	Optometrist	4763/T1567	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245230119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER C LONG O.D.

Provider Business Mailing Address
First Line	:	2315 SUNSET BLVD
Second Line	:	STE B
City	:	STEUBENVILLE
State	:	OH
Zip	:	43952-2496
Country	:	US
Telephone Number	:	740-264-7148
Fax Number	:	740-264-6957

Provider Business Practice Location Address
First Line	:	2315 SUNSET BLVD
Second Line	:	STE B
City	:	STEUBENVILLE
State	:	OH
Zip	:	43952-2496
Country	:	US
Telephone Number	:	740-264-7148
Fax Number	:	740-264-6957

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	09/04/2014

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