Provider Demographics
NPI:1265656524
Name:LONG, BRANDI LA'SHELLE (OD)
Entity type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:LA'SHELLE
Last Name:LONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9 BASCOM RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-8800
Mailing Address - Country:US
Mailing Address - Phone:731-267-0040
Mailing Address - Fax:731-427-7657
Practice Address - Street 1:547 W CHURCH ST
Practice Address - Street 2:WAL-MART VISION CENTER
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-1703
Practice Address - Country:US
Practice Address - Phone:731-450-0120
Practice Address - Fax:731-968-5595
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2546152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist