NPIMap

Organization Active NPI

Longe Optical Inc

  • Eyewear Supplier
  • Ft Wayne, IN
National Provider Identifier
1396798963
Registry record updated Jan 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
LONGE OPTICAL INC
Practice address
3409 N Anthony Blvd
Ft Wayne, IN 46805
Phone
(260) 484-2691
NPI assigned
May 18, 2006
Reactivated
Mar 28, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Martha C Davenport
Title
Office Manager
Phone
(260) 347-1128

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X IN Primary

Addresses

Primary practice location

3409 N Anthony Blvd
Ft Wayne, IN 46805

Mailing address

3409 N Anthony Blvd
Ft. Wayne, IN 46805
Phone (260) 484-2691

Other identifiers 2

IdentifierTypeStateIssuer
100173460MedicaidIN
100173460EMedicaidIN

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296172800000",
    "number": "1396798963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3409 N ANTHONY BLVD",
            "city": "FT. WAYNE",
            "state": "IN",
            "postal_code": "46805",
            "telephone_number": "260-484-2691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3409 N ANTHONY BLVD",
            "city": "FT WAYNE",
            "state": "IN",
            "postal_code": "46805",
            "telephone_number": "260-484-2691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGE OPTICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2011-01-28",
        "deactivation_date": "2007-01-16",
        "reactivation_date": "2008-03-28",
        "status": "A",
        "authorized_official_last_name": "DAVENPORT",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "260-347-1128",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100173460",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100173460E",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ft Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.