Provider Demographics
NPI:1346212982
Name:GLASZ, LAURA M (OD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:GLASZ
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 1:2880 OLD DIXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518
Mailing Address - Country:US
Mailing Address - Phone:203-248-6365
Mailing Address - Fax:203-281-2742
Practice Address - Street 1:2880 OLD DIXWELL AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518
Practice Address - Country:US
Practice Address - Phone:203-248-6365
Practice Address - Fax:203-281-2742
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000881152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008020997Medicaid
T92703Medicare UPIN
CT410000944Medicare PIN