Active NPI
Daniel J Long, OD
- Optometrist
- Mandan, ND
National Provider Identifier
1891894564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 383
- Practice address
- 113 3Rd Ave NW
Mandan, ND 58554-3129 - Phone
- (701) 663-2020
- Fax
- (701) 667-2057
- NPI assigned
- Sep 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 383 | ND | Primary |
Addresses
Primary practice location
113 3Rd Ave NW
Mandan, ND 58554-3129
Mailing address
113 3Rd Ave NW
Mandan, ND 58554-3129
Phone (701) 663-2020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60231 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193270400000",
"number": "1891894564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "113 3RD AVE NW",
"city": "MANDAN",
"state": "ND",
"postal_code": "585543129",
"telephone_number": "701-663-2020",
"fax_number": "701-667-2057"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "113 3RD AVE NW",
"city": "MANDAN",
"state": "ND",
"postal_code": "585543129",
"telephone_number": "701-663-2020",
"fax_number": "701-667-2057"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONG",
"first_name": "DANIEL",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-21",
"last_updated": "2007-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "ND",
"license": "383",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "60231",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mandan, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.