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General NPI Number Information
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NPI Number | 1073654802
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Entity Type | Individual
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Provider Name | GLENNA ANNE WAITT O.D.
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Gender | Female
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/10/2020
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Provider Practice Location Address
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Address Line | BJS OPTICAL GLENNA WAITT OD
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City | PLYMOUTH
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State | MA
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Zip | 02360
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Country | US
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Telephone | 508-732-0420
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Fax |
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Provider Business Mailing Address
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Address Line | 74 SURF AVE
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City | MARSHFIELD
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State | MA
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Zip | 02050-6746
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Country | US
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Telephone | 781-834-2235
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2957
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License Number State | MA
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