Provider Demographics
NPI:1750978987
Name:LONGNECKER OPTOMETRY LLC
Entity type:Organization
Organization Name:LONGNECKER OPTOMETRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGNECKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:217-942-3300
Mailing Address - Street 1:324 A FIFTH ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:IL
Mailing Address - Zip Code:62016
Mailing Address - Country:US
Mailing Address - Phone:217-942-3300
Mailing Address - Fax:217-942-3306
Practice Address - Street 1:324 A FIFTH ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:IL
Practice Address - Zip Code:62016
Practice Address - Country:US
Practice Address - Phone:217-942-3300
Practice Address - Fax:217-942-3306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty