Healthcare Provider Details

I. General information

NPI: 1649200270
Provider Name (Legal Business Name): GLENN J. MINER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 N 32ND ST STE. 2
PHOENIX AZ
85008-5107
US

IV. Provider business mailing address

6420 E LOWDEN RD
CAVE CREEK AZ
85331-6128
US

V. Phone/Fax

Practice location:
  • Phone: 602-267-7573
  • Fax: 602-267-7595
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number491
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number491
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: