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General NPI Number Information
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NPI Number | 1184212946
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Entity Type | Organization
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Legal Business Name | GLAZE OPTICAL, INC
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Dates
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Enumeration Date | 01/07/2021
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 2275 MICHAEL FARADAY DR STE 4
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City | SAN DIEGO
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State | CA
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Zip | 92154-7927
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Country | US
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Telephone | 805-630-7375
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Fax |
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Provider Business Mailing Address
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Address Line | 186 E RADCLIFFE DR
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City | CLAREMONT
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State | CA
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Zip | 91711-2832
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Country | US
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Telephone | 805-630-7375
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TONY MARIO ESPOSITO
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Credential |
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Telephone | 805-630-7375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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