Provider Demographics
NPI:1972848018
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:INSURANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUEX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-484-0615
Mailing Address - Street 1:7625 SOUTHTOWN XING
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46816-2517
Mailing Address - Country:US
Mailing Address - Phone:260-447-3583
Mailing Address - Fax:260-441-8276
Practice Address - Street 1:7625 SOUTHTOWN XING
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46816-2517
Practice Address - Country:US
Practice Address - Phone:260-447-3583
Practice Address - Fax:260-441-8276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-30
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier