Provider Demographics
NPI:1932216272
Name:GLANZER, MICHAEL J (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:GLANZER
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:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:360-242-3008
Mailing Address - Fax:360-807-7687
Practice Address - Street 1:2205 NE 129TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3252
Practice Address - Country:US
Practice Address - Phone:360-694-2544
Practice Address - Fax:360-694-1356
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003714152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA410047089OtherRAILROAD MEDICARE
AK1023377Medicaid
OR299052Medicaid
WA410047090OtherRAILROAD MEDICARE
WA410047091OtherRAILROAD MEDICARE
MT1932216272Medicaid
WA1022578Medicaid
ID1932216272Medicaid
MT410047407OtherRAILROAD MEDICARE
WAGAB26880Medicare PIN
WA410047090OtherRAILROAD MEDICARE
WAGAB26974Medicare PIN
WAGAB26971Medicare PIN
AK160068Medicare PIN