Provider Demographics
NPI:1528825635
Name:LONG, SARAH REBEKAH
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:REBEKAH
Last Name:LONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 N 12TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-1838
Mailing Address - Country:US
Mailing Address - Phone:606-248-5389
Mailing Address - Fax:606-248-5289
Practice Address - Street 1:1255 N 12TH ST STE 1
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-1838
Practice Address - Country:US
Practice Address - Phone:606-248-5389
Practice Address - Fax:606-248-5289
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY287661156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician