Provider Demographics
NPI:1699818294
Name:GLENDON, HOWARD A (OD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:A
Last Name:GLENDON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8404 BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3402
Mailing Address - Country:US
Mailing Address - Phone:323-655-9755
Mailing Address - Fax:323-651-4436
Practice Address - Street 1:8404 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3402
Practice Address - Country:US
Practice Address - Phone:323-655-9755
Practice Address - Fax:323-651-4436
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4085152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist