Jacqlyn E Long, OD | |
211 E Broadway, Alton, IL 62002-6220 | |
(618) 462-9818 | |
(314) 741-4947 |
Full Name | Jacqlyn E Long |
---|---|
Gender | Female |
Speciality | Optometry |
Experience | 35 Years |
Location | 211 E Broadway, Alton, Illinois |
Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1992866057 | NPI | - | NPPES |
0854830001 | Other | DMERC | |
318096041 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | T02865 (Missouri) | Secondary |
152W00000X | Optometrist | 046-008207 (Illinois) | Primary |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
Nucrown, Llc | 1456256346 | 19 |
Provider Name | Nucrown, Llc |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1295737294 PECOS PAC ID: 1456256346 Enrollment ID: O20041025000051 |
Mailing Address | Practice Location Address |
---|---|
Jacqlyn E Long, OD 8885 Ladue Rd, Saint Louis, MO 63124-2088 Ph: (314) 721-2720 | Jacqlyn E Long, OD 211 E Broadway, Alton, IL 62002-6220 Ph: (618) 462-9818 |
Aeg Delaware Professional Pa Optometrist Medicare: Not Enrolled in Medicare Practice Location: 111 E 4th St Ste 440, Alton, IL 62002 Phone: 618-462-9818 | |
Aeg Connecticut Professional Pllc Optometrist Medicare: Medicare Enrolled Practice Location: 111 E 4th St Ste 440, Alton, IL 62002 Phone: 618-462-9818 Fax: 314-741-4947 | |
Dr. James Walter Lieber, O.D. Optometrist Medicare: Medicare Enrolled Practice Location: 401 Henry St, Alton, IL 62002 Phone: 618-465-6000 | |
Mark D. Wade O D P C Optometrist Medicare: Not Enrolled in Medicare Practice Location: 111 E 4th St Ste 440, Alton, IL 62002 Phone: 618-462-9818 Fax: 314-741-4947 | |
Crown Vision Center Optometrist Medicare: Medicare Enrolled Practice Location: 111 E 4th St Ste 440, Alton, IL 62002 Phone: 618-462-9818 Fax: 314-741-4947 | |
Clarkson Eyecare Optometrist Medicare: Not Enrolled in Medicare Practice Location: 1819 Homer Adams Parkway, Suite B, Alton, IL 62002 Phone: 636-200-4393 Fax: 636-938-2650 | |
Pearle Vision Of Alton, P.c. Optometrist Medicare: Not Enrolled in Medicare Practice Location: 2865 Homer M Adams Pkwy, Alton, IL 62002 Phone: 618-465-1654 Fax: 618-465-8652 |