MEDICARE: DR. DEBORAH A. LONG OD

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	677	SC

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	:	1710968326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH A. LONG OD

Provider Business Mailing Address
First Line	:	1090 SPRATT ST
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-8226
Country	:	US
Telephone Number	:	803-547-5547
Fax Number	:	803-547-5724

Provider Business Practice Location Address
First Line	:	1090 SPRATT ST
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-8226
Country	:	US
Telephone Number	:	803-547-5547
Fax Number	:	803-547-5724

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	03/08/2021

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