Provider Demographics
NPI:1023126182
Name:LONG, J. RAMEY (OD)
Entity type:Individual
Prefix:DR
First Name:J.
Middle Name:RAMEY
Last Name:LONG
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 1:1521 GUNTER AVE
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-1847
Mailing Address - Country:US
Mailing Address - Phone:256-582-3146
Mailing Address - Fax:256-582-4851
Practice Address - Street 1:1521 GUNTER AVE
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-1847
Practice Address - Country:US
Practice Address - Phone:256-582-3146
Practice Address - Fax:256-582-4851
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS369-TA156152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS369TA156OtherSTATE LICENSE
AL51030292Medicare ID - Type Unspecified
ALS369TA156OtherSTATE LICENSE