Provider Demographics
NPI:1518202431
Name:LONGE ENTERPRISES CORP
Entity Type:Organization
Organization Name:LONGE ENTERPRISES CORP
Other - Org Name:LONGE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOXBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-423-9411
Mailing Address - Street 1:6709 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6209
Mailing Address - Country:US
Mailing Address - Phone:260-432-8409
Mailing Address - Fax:
Practice Address - Street 1:6709 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6209
Practice Address - Country:US
Practice Address - Phone:260-432-8409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier