Provider Demographics
NPI:1245230119
Name:LONG, CHRISTOPHER C (OD)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:C
Last Name:LONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2315 SUNSET BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2496
Mailing Address - Country:US
Mailing Address - Phone:740-264-7148
Mailing Address - Fax:740-264-6957
Practice Address - Street 1:2315 SUNSET BLVD
Practice Address - Street 2:STE B
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2496
Practice Address - Country:US
Practice Address - Phone:740-264-7148
Practice Address - Fax:740-264-6957
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4763/T1567152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2154930Medicaid
OH0686330001Medicare NSC
OHU64062Medicare UPIN
OHLO814562Medicare PIN