Long, Susan
Long, Susan is an sole proprietor health care provider with primary practice located at 1300 W I-40 Frontage Rd Ste 322 , Gallup NM 87301-3323. She recently has only one registered license in Eye and Vision Services Providers / Optician, which is considered as her primary health care specialty. Long, Susan can be contacted via phone (505) 722-3030.Contact Information
Primary practice address
1300 W I-40 Frontage Rd Ste 322
Gallup NM 87301-3323
Phone: (505) 722-3030
Fax: (505) 722-0367
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optician | 156FX1800X | 03-037772-00-2 | New Mexico |
Profile Details
| NPI number | 1326104787 |
|---|---|
| LBN Legal business name | Long, Susan |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 29th, 2006 |
| Last updated | Jul 8th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1326104787 | NPPES |
| New Mexico | MEDICAID | 90481763 |
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