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Contact Information

MICHAEL J LONG, OD
1110 N MAIN ST
EDGERTON, WI53534
 Phone: 608-884-3314
 Fax: 608-884-4923
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for MICHAEL J LONG · (Male)

NPI # 1093729584
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 07/28/2006
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 No
Identifiers
  • WI License # 1749
  • WI Medicaid 38514300
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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