Provider Demographics
NPI:1154595593
Name:GLATT, CLARKE
Entity type:Individual
Prefix:MR
First Name:CLARKE
Middle Name:
Last Name:GLATT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 S HUNT CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4958
Mailing Address - Country:US
Mailing Address - Phone:407-862-2020
Mailing Address - Fax:407-862-6730
Practice Address - Street 1:612 S HUNT CLUB BLVD
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4958
Practice Address - Country:US
Practice Address - Phone:407-862-2020
Practice Address - Fax:407-862-6730
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO1580156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1050850001Medicare NSC