Provider Demographics
NPI:1497169403
Name:LONG, JAYME NICOLE KASTING (OD)
Entity Type:Individual
Prefix:DR
First Name:JAYME
Middle Name:NICOLE KASTING
Last Name:LONG
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:1110 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:WI
Mailing Address - Zip Code:53534-1328
Mailing Address - Country:US
Mailing Address - Phone:608-884-3314
Mailing Address - Fax:608-884-4923
Practice Address - Street 1:641 E SAINT MARY ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WI
Practice Address - Zip Code:53563-3719
Practice Address - Country:US
Practice Address - Phone:608-868-4651
Practice Address - Fax:608-884-4923
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2021-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN18003848A152W00000X
WI3443-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist