Provider Demographics
NPI:1730238080
Name:GLENN BAGGS, OD, PC
Entity type:Organization
Organization Name:GLENN BAGGS, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:BAGGS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-687-9898
Mailing Address - Street 1:501 N MAIN ST
Mailing Address - Street 2:SUITE 36B
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-6348
Mailing Address - Country:US
Mailing Address - Phone:918-687-9898
Mailing Address - Fax:918-683-1990
Practice Address - Street 1:501 N MAIN ST
Practice Address - Street 2:SUITE 36B
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-6348
Practice Address - Country:US
Practice Address - Phone:918-687-9898
Practice Address - Fax:918-683-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2089152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100747780AMedicaid
OK100747780AMedicaid