Healthcare Provider Details

I. General information

NPI: 1346212982
Provider Name (Legal Business Name): LAURA M GLASZ OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 02/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 OLD DIXWELL AVE
HAMDEN CT
06518
US

IV. Provider business mailing address

2880 OLD DIXWELL AVE
HAMDEN CT
06518
US

V. Phone/Fax

Practice location:
  • Phone: 203-248-6365
  • Fax: 203-281-2742
Mailing address:
  • Phone: 203-248-6365
  • Fax: 203-281-2742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number000881
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: