MEDICARE: DEREK S LONG OD INC

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	2547	AR

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	:	1255577532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEREK S LONG OD INC

Provider Business Mailing Address
First Line	:	406 W PERSHING BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-2146
Country	:	US
Telephone Number	:	501-753-3145
Fax Number	:	501-753-1806

Provider Business Practice Location Address
First Line	:	406 W PERSHING BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-2146
Country	:	US
Telephone Number	:	501-753-3145
Fax Number	:	501-753-1806

Authorized Official
Title or Position	:	DOCTOR
Name	:	DEREK S LONG
Credential	:	O.D.
Telephone Number	:	501-803-3937

Provider Enumeration Date	:	12/17/2008
Last Update Date	:	05/31/2011

Similar Medicare Providers

1649411018 — 152W00000X - OPTOMETRIST NORTH PHOENIX EYE CARE
Practice Location Address:

19401 N CAVE CREEK RD , #7
PHOENIX, AZ
85024-1801

Practice Phone: 623-229-8185
Practice Fax:

1770561532 — DARIN KEITH WILBOURN MD
Practice Location Address:

410 W PERSHING BLVD
NORTH LITTLE ROCK, AR
72114-2146

Practice Phone: 501-771-0674
Practice Fax: 501-753-4174

1790749943 — ROSE MARIE SHAW-BULLOCK M.D.
Practice Location Address:

400 W PERSHING BLVD
N LITTLE ROCK, AR
72114-2146

Practice Phone: 501-771-7717
Practice Fax: 501-771-0550

1306877576 — NORTH LITTLE ROCK PRIMARY CARE AND DIAGNOSTIC CLINIC PLLC
Practice Location Address:

400 W PERSHING BLVD
N LITTLE ROCK, AR
72114-2146

Practice Phone: 501-771-7717
Practice Fax: 501-771-0550

1487735718 — DR. JERRY L. SHUE
Practice Location Address:

406 W PERSHING BLVD
N LITTLE ROCK, AR
72114-2146

Practice Phone: 501-753-3145
Practice Fax: 501-753-1806

1942360052 — DR. JOE LEE BUFORD MD
Practice Location Address:

410 W PERSHING BLVD
NORTH LITTLE ROCK, AR
72114-2146

Practice Phone: 501-771-0674
Practice Fax: 501-753-4147

1528224508 — LATONYA HARRIS
Practice Location Address:

400 W PERSHING BLVD
NORTH LITTLE ROCK, AR
72114-2146

Practice Phone: 501-771-7717
Practice Fax: 501-771-0550

Directions to “DEREK S LONG OD INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.