Provider Demographics
NPI:1073651279
Name:LONG, TONYA D (OD)
Entity Type:Individual
Prefix:DR
First Name:TONYA
Middle Name:D
Last Name:LONG
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:12300 JEFFERSON AVE
Mailing Address - Street 2:904
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-6900
Mailing Address - Country:US
Mailing Address - Phone:757-249-4404
Mailing Address - Fax:757-249-4761
Practice Address - Street 1:12300 JEFFERSON AVE
Practice Address - Street 2:904
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-6900
Practice Address - Country:US
Practice Address - Phone:757-249-4404
Practice Address - Fax:757-249-4761
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0618001095152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541825629OtherTAX ID