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General NPI Number Information
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NPI Number | 1306023700
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Entity Type | Organization
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Legal Business Name | JOSEPH R GLENNON OD
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 08/26/2008
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Provider Practice Location Address
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Address Line | 1212 KEMPTON ST
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City | NEW BEDFORD
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State | MA
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Zip | 02740-1503
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Country | US
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Telephone | 508-997-3222
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Fax | 508-997-6848
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Provider Business Mailing Address
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Address Line | 1212 KEMPTON ST
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City | NEW BEDFORD
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State | MA
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Zip | 02740-1503
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Country | US
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Telephone | 508-997-3222
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Fax | 508-997-6848
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH R GLENNON III
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Credential | O.D.
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Telephone | 508-997-3222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 2169
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License Number State | MA
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