MEDICARE: D GLEN JOSEPH PLLC

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	OPC 3971	FL

General Provider Information

NPI Number	:	1851798078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D GLEN JOSEPH PLLC

Provider Business Mailing Address
First Line	:	21533 HALSTEAD DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-4844
Country	:	US
Telephone Number	:	561-715-2737
Fax Number	:	954-431-0745

Provider Business Practice Location Address
First Line	:	12055 PINES BLVD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33026-4112
Country	:	US
Telephone Number	:	954-638-3139
Fax Number	:	954-431-0745

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DARRYL GLEN JOSEPH
Credential	:	OD
Telephone Number	:	561-715-2737

Provider Enumeration Date	:	12/03/2014
Last Update Date	:	12/03/2014

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