Provider Demographics
NPI:1457431868
Name:NEUFELD, GLENN ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ALAN
Last Name:NEUFELD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1900
Mailing Address - Country:US
Mailing Address - Phone:973-726-9679
Mailing Address - Fax:973-726-9606
Practice Address - Street 1:4 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1900
Practice Address - Country:US
Practice Address - Phone:973-726-9679
Practice Address - Fax:973-726-9606
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00495100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ167911Y47Medicare PIN