Provider Demographics
NPI:1487935995
Name:GLOVER, DARRYL E JR (O,D,)
Entity type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:E
Last Name:GLOVER
Suffix:JR
Gender:M
Credentials:O,D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8231 BRIER CREEK PKWY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7705
Practice Address - Country:US
Practice Address - Phone:919-863-5032
Practice Address - Fax:919-226-0040
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2246152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5919007Medicaid
NC0933XOtherNCBCBS
NCNC3539HMedicare PIN
NCNC3539JMedicare PIN
NC5919007Medicaid
NCNC3539EMedicare PIN
NCNC3539DMedicare PIN
NCNC3539GMedicare PIN
NCNC3539LMedicare PIN
NCNC3539FMedicare PIN
NCNC3539KMedicare PIN
NC0933XOtherNCBCBS
NCNC3539IMedicare PIN
NCNC3539BMedicare PIN