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General NPI Number Information
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NPI Number | 1093750317
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Entity Type | Individual
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Provider Name | GLENN HOWARD HERMANN O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 3416 VIRGINIA AVE SUITE #3
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City | COLLINSVILLE
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State | VA
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Zip | 24078-2240
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Country | US
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Telephone | 276-747-4488
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Fax | 276-647-7569
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Provider Business Mailing Address
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Address Line | 3416 VIRGINIA AVE SUITE #3
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City | COLLINSVILLE
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State | VA
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Zip | 24078-2240
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Country | US
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Telephone | 276-747-4488
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Fax | 276-647-7569
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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 | 0618000497
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 0618000497
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License Number State | VA
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