Provider Demographics
NPI:1306023700
Name:JOSEPH R GLENNON OD
Entity type:Organization
Organization Name:JOSEPH R GLENNON OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:GLENNON
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:508-997-3222
Mailing Address - Street 1:1212 KEMPTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-1503
Mailing Address - Country:US
Mailing Address - Phone:508-997-3222
Mailing Address - Fax:508-997-6848
Practice Address - Street 1:1212 KEMPTON ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-1503
Practice Address - Country:US
Practice Address - Phone:508-997-3222
Practice Address - Fax:508-997-6848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2169332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0481020001Medicare NSC