Healthcare Provider Details

I. General information

NPI: 1710067954
Provider Name (Legal Business Name): STEPHEN LAWRENCE GLASSER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 17TH ST NW SUITE 400
WASHINGTON DC
20006
US

IV. Provider business mailing address

900 17TH ST NW SUITE 400
WASHINGTON DC
20006
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 TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOP421
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP421
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: