Provider Demographics
NPI:1124083530
Name:DR ALAN N GLAZIER OPTOMETRIST PA
Entity type:Organization
Organization Name:DR ALAN N GLAZIER OPTOMETRIST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:GLAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-670-1212
Mailing Address - Street 1:15200 SHADY GROVE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-670-1212
Mailing Address - Fax:301-216-9692
Practice Address - Street 1:15200 SHADY GROVE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:301-670-1212
Practice Address - Fax:301-216-9692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1210152W00000X
MDTA1733152W00000X
MDTA1820152W00000X
MDTA0733152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD891346Medicare ID - Type Unspecified
0626090001Medicare NSC
VA891346Medicare ID - Type Unspecified
U62934Medicare UPIN
DC891346Medicare ID - Type Unspecified