Edgerton Vision Center | |
1110 N Main St, Edgerton, WI 53534-1328 | |
(608) 884-3314 | |
(608) 884-4923 |
Full Name | Edgerton Vision Center |
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Type | Facility |
Speciality | Optometrist |
Location | 1110 N Main St, Edgerton, Wisconsin |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1194932111 | NPI | - | NPPES |
38514300 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 1749 (Wisconsin) | Primary |
Provider Name | Tristan M Long |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1780021667 PECOS PAC ID: 7517108715 Enrollment ID: I20130731000392 |
Provider Name | Jayme Nicole Kasting Long |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1497169403 PECOS PAC ID: 5991923641 Enrollment ID: I20170124002122 |
Mailing Address | Practice Location Address |
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Edgerton Vision Center 1110 N Main St, Edgerton, WI 53534-1328 Ph: (608) 884-3314 | Edgerton Vision Center 1110 N Main St, Edgerton, WI 53534-1328 Ph: (608) 884-3314 |
Dr. Michael James Long, OD Optometrist Medicare: Medicare Enrolled Practice Location: 1110 N Main St, Edgerton, WI 53534 Phone: 608-884-3314 Fax: 608-884-4923 | |
Dr. Tristan Michael Long, O.D. Optometrist Medicare: May Accept Medicare Assignments Practice Location: 1110 N Main St, Edgerton, WI 53534 Phone: 608-884-3314 Fax: 608-884-4923 |