Provider Demographics
NPI:1194906727
Name:IGLASS STUDIO, LLC
Entity type:Organization
Organization Name:IGLASS STUDIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:MINH-TU
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:603-672-0338
Mailing Address - Street 1:603 NASHUA ST
Mailing Address - Street 2:UNIT 3
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-4924
Mailing Address - Country:US
Mailing Address - Phone:603-672-0338
Mailing Address - Fax:603-672-5228
Practice Address - Street 1:603 NASHUA ST
Practice Address - Street 2:UNIT 3
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-4924
Practice Address - Country:US
Practice Address - Phone:603-672-0338
Practice Address - Fax:603-672-5228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH717261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30351596Medicaid
NH30351596Medicaid
NH6252920001Medicare NSC