Provider Demographics
NPI:1609226034
Name:LUONGO, ANTHONY G (OD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:G
Last Name:LUONGO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-2929
Mailing Address - Country:US
Mailing Address - Phone:899-356-3937
Mailing Address - Fax:899-356-3938
Practice Address - Street 1:1011 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-2929
Practice Address - Country:US
Practice Address - Phone:899-356-3937
Practice Address - Fax:899-356-3938
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2032152W00000X
MI4901005586152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist