Provider Demographics
NPI:1700070083
Name:LONG SIGHT, PC
Entity type:Organization
Organization Name:LONG SIGHT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILDA
Authorized Official - Middle Name:EDEAN
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-875-8036
Mailing Address - Street 1:4251 TWIN MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:VA
Mailing Address - Zip Code:24179-1021
Mailing Address - Country:US
Mailing Address - Phone:540-875-8036
Mailing Address - Fax:888-840-8937
Practice Address - Street 1:22 CAMPBELL AVE SE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24011-1404
Practice Address - Country:US
Practice Address - Phone:540-982-7890
Practice Address - Fax:540-982-7891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001106261Q00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADO5547OtherRAILROAD MEDICARE GROUP PTAN
VA1700070083OtherRAILROAD MEDICARE GROUP NPI
VA009237674Medicaid
VA410047559OtherRAILROAD MEDICARE GROUP PTAN
VA410047559OtherRAILROAD MEDICARE GROUP PTAN