Provider Demographics
NPI:1679251797
Name:TJOE-A-LONG, FAITH (OD)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:TJOE-A-LONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15795 E ARAPAHOE RD
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80016-1782
Mailing Address - Country:US
Mailing Address - Phone:303-680-1987
Mailing Address - Fax:303-680-6421
Practice Address - Street 1:15795 E ARAPAHOE RD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80016-1782
Practice Address - Country:US
Practice Address - Phone:303-680-1987
Practice Address - Fax:303-680-6421
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003950152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist