MEDICARE: DR. PEYTON GLASS OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	33665	CA

General Provider Information

NPI Number	:	1356878565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PEYTON GLASS OD

Provider Business Mailing Address
First Line	:	8907 WILSHIRE BLVD FL 3
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-1930
Country	:	US
Telephone Number	:	310-276-5333
Fax Number	:

Provider Business Practice Location Address
First Line	:	8907 WILSHIRE BLVD FL 3
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-1930
Country	:	US
Telephone Number	:	310-276-5333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2017
Last Update Date	:	11/29/2017

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