Healthcare Provider Details

I. General information

NPI: 1558541540
Provider Name (Legal Business Name): STEPHEN L GLASSER OD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 17TH ST NW SUITE 200
WASHINGTON DC
20036-5503
US

IV. Provider business mailing address

1050 17TH ST NW SUITE 200
WASHINGTON DC
20036-5503
US

V. Phone/Fax

Practice location:
  • Phone: 202-223-3530
  • Fax: 202-223-9748
Mailing address:
  • Phone: 202-223-3530
  • Fax: 202-223-9748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP421
License Number StateDC

VIII. Authorized Official

Name: DR. STEPHEN LAWRENCE GLASSER
Title or Position: PRESIDENT
Credential: O.D.
Phone: 202-223-3530