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General NPI Number Information
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NPI Number | 1063735520
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Entity Type | Organization
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Legal Business Name | DR. GLEN A. LINSLEY OPTOMETRIST, PC
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 12/21/2010
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Provider Practice Location Address
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Address Line | 109 E MAPLE ST
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City | MASON
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State | MI
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Zip | 48854-1655
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Country | US
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Telephone | 517-676-4499
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Fax | 517-676-3221
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Provider Business Mailing Address
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Address Line | 109 E MAPLE ST
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City | MASON
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State | MI
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Zip | 48854-1655
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Country | US
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Telephone | 517-676-4499
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Fax | 517-676-3221
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Authorized Official
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Title or Position | MEDICAL BILLER
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Name | MRS. MICHELLE HEBERLEIN
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Credential |
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Telephone | 517-623-6260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | GL002568
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License Number State | MI
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