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NPI Code Detail

MEDICARE: CATHERINE WITHROW LONG O.D.

MEDICARE: CATHERINE WITHROW 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
1152W00000XOptometrist2474TN

General Provider Information

NPI Number : 1982964300
Entity Type Code : Individual
Provider Name (Legal Business Name) : CATHERINE WITHROW LONG O.D.
Provider Business Mailing Address
First Line : 907 WOODMONT DR
Second Line :
City : MURFREESBORO
State : TN
Zip : 37129-1887
Country : US
Telephone Number : 615-904-9314
Fax Number :
Provider Business Practice Location Address
First Line : 2000 OLD FORT PKWY
Second Line :
City : MURFREESBORO
State : TN
Zip : 37129-6907
Country : US
Telephone Number : 615-848-3008
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2012
Last Update Date : 05/18/2012

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