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NPI Code Detail

MEDICARE: LONGE OPTICAL- NORTH INC.

MEDICARE: LONGE OPTICAL- NORTH 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
1332H00000XEyewear Supplier

Other Identifiers

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

General Provider Information

NPI Number : 1548593072
Entity Type Code : Organization
Provider Name (Legal Business Name) : LONGE OPTICAL- NORTH INC.
Provider Business Mailing Address
First Line : 5721 COVENTRY LN
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-7146
Country : US
Telephone Number : 260-432-8409
Fax Number : 260-432-8506
Provider Business Practice Location Address
First Line : 5721 COVENTRY LN
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-7146
Country : US
Telephone Number : 260-432-8409
Fax Number : 260-432-8506
Authorized Official
Title or Position : STORE MANAGER
Name : MR. BRENT BAIR
Credential :
Telephone Number : 260-432-8409
Provider Enumeration Date : 09/16/2009
Last Update Date : 10/07/2009

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Directions to “LONGE OPTICAL- NORTH INC. ” Practice Location

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