MEDICARE: DRS GLENN & GLENN INC

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	11533	KS

General Provider Information

NPI Number	:	1518089374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS GLENN & GLENN INC

Provider Business Mailing Address
First Line	:	702 N KANSAS ST
Second Line	:
City	:	RUSSELL
State	:	KS
Zip	:	67665-2043
Country	:	US
Telephone Number	:	785-483-2451
Fax Number	:	785-798-4986

Provider Business Practice Location Address
First Line	:	702 N KANSAS ST
Second Line	:
City	:	RUSSELL
State	:	KS
Zip	:	67665-2043
Country	:	US
Telephone Number	:	785-483-2451
Fax Number	:	785-798-4986

Authorized Official
Title or Position	:	TECHNICIAN
Name	:	MELANIE B BANKS
Credential	:
Telephone Number	:	785-483-2451

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	06/02/2016

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Directions to “DRS GLENN & GLENN INC ” Practice Location

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