DR. JERRY WAYNE LONG (NPI# 1144295197) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144295197 |
| Entity Type | Individual |
| Full Name | DR. JERRY WAYNE LONG |
| Credential | O.D |
| Practice Address |
213 N Broadway St Poplar Bluff MO 63901-5135 |
| Practice Telephone | 5737858476 |
| Practice Fax Number | 5737858477 |
| Mailing Telephone | 5737858476 |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2014-07-03 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | T02229 | MO | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 310038807 | 05 | |
| MO | GROUP NUMBER | 990001270 | 01 |
| MO | MEDICARE P-TAN | 000006948 | 01 |
| MO | 500398706 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881240349 | Jerry Lee Long Jr. | Durable Medical Equipment & Medical Supplies | 6654 Bitteroot Ln, Saint Louis, MO 63134-1451 | 2019-08-12 |
| 1821004722 | Jerry Murrel Long | Dentist | 1642 E Catalpa St, Springfield, MO 65804-0202 | 2006-07-31 |
| 1346427796 | Jerry Long | Case Manager/Care Coordinator | 6701 Highway 67, Benton, AR 72015-8909 | 2008-01-29 |
| Street Address |
213 N BROADWAY ST |
| City | POPLAR BLUFF |
| State | MO |
| Zip Code | 63901-5135 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013305721 | Drjerry W Long Optometry | Optometrist | 213 N Broadway St, Poplar Bluff, MO 63901-5135 | 2015-01-05 |
| 1073719910 | Dr Jerry W Long Optometry | Optometrist | 213 N Broadway St, Poplar Bluff, MO 63901-5135 | 2007-06-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568076701 | Alternative Sleep Solution | Dentist | 2700 Kanell Blvd., Poplar Bluff, MO 63901 | 2020-09-04 |
| 1285271239 | Front Door Wellness LLC | Physical Therapist | Front Door Wellness LLC, 5835 Quail Meadows Drive, Poplar Bluff, MO 63901 | 2019-12-09 |
| 1104470368 | Andrew Akindutire | Dentist | 3101 Oak Groove Rd., Suite 6, Poplar Bluff, MO 63901 | 2019-07-26 |
| 1780195966 | Midwest Equipment Srv Systems LLC | Technician, Pathology | 2400 Lucy Lee Parkway, Suite C, Poplar Bluff, MO 63901 | 2017-10-16 |
| 1801259387 | Richard Justin Huber | Technician, Other | 3005 Warrior Ln, Poplar Bluff, MO 63901 | 2016-04-01 |
| 1699136275 | Donja Kirkland | Recreation Therapist | 1910a Greenwood Dr., Suite D, Poplar Bluff, MO 63901 | 2016-03-10 |
| 1760866867 | Bio-medical Applications of Missouri, Inc. | Clinic/Center | 3050 Tucker Road, Poplar Bluff, MO 63901 | 2015-07-17 |
| 1407246390 | Lisa Marie Payne | Physical Therapist | 4358c Highway Pp, Poplar Bluff, MO 63901 | 2015-01-29 |
| 1700202488 | Missouri Dental Professionals, Richard Straus, Dmd, PC | Dentist | 1602 W. Harper Street, Poplar Bluff, MO 63901 | 2014-03-05 |
| 1932521648 | Essential Family Healthcare, LLC | Clinic/Center | 1369 North Westwood Blvd., Poplar Bluff, MO 63901 | 2014-01-15 |
| Find all providers in zip 63901 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316553373 | Eye Surgery Consultants LLC | Optometrist | 2530 Lucy Lee Pkwy, Poplar Bluff, MO 63901-2436 | 2020-09-16 |
| 1871859918 | Divine Family Eye Care, LLC | Optometrist | 1347 N. Westwood Blvd., Poplar Bluff, MO 63901 | 2012-04-03 |
| 1558672162 | Kylie Marie Divine | Optometrist | 1347 North Westwood Blvd., Poplar Bluff, MO 63901 | 2010-06-29 |
| 1205007614 | Dr. Daniel R. Obermark Optometry PC | Optometrist | 1909 N. Westwood Blvd., Poplar Bluff, MO 63901-2807 | 2008-03-13 |
| 1326228578 | Kramer Family Vision | Optometrist | 225 Physicians Park Dr, Suite 107, Poplar Bluff, MO 63901 | 2007-11-05 |
| 1205970159 | Troy L Bell | Optometrist | 2751 N Westwood Blvd, Poplar Bluff, MO 63901-2346 | 2007-02-16 |
| 1528123056 | Teri Lynn Page | Optometrist | 1916 N Westwood Blvd, Poplar Bluff, MO 63901-2808 | 2006-12-26 |
| 1487752044 | Michael R. Penney | Optometrist | 3061 N Westwood Blvd, Poplar Bluff, MO 63901-8658 | 2006-09-20 |
| 1922058429 | Derek Joseph Melton | Optometrist | 4061 Hwy Pp Suite 1, Melton Eye Care Associates, Poplar Bluff, MO 63901 | 2006-05-12 |
| 1629052550 | Paul Varner | Optometrist | 1500 N Westwood Boulevard, Poplar Bluff, MO 63901 | 2005-12-05 |
| Find all providers in POPLAR BLUFF | ||||
| City | POPLAR BLUFF |
| Zip Code | 63901 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.