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General NPI Number Information
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NPI Number | 1326377151
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Entity Type | Individual
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Provider Name | DAVID KRISTOPHER GLABE O.D., M.S.
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Gender | Male
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Dates
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Enumeration Date | 12/07/2009
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Last Update Date | 08/20/2013
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Provider Practice Location Address
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Address Line | 1502 N PINE ST #3
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City | LA GRANDE
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State | OR
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Zip | 97850-3543
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Country | US
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Telephone | 541-963-3788
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Fax |
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Provider Business Mailing Address
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Address Line | 10801 EMILY DR
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City | ISLAND CITY
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State | OR
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Zip | 97850-8509
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Country | US
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Telephone | 402-430-2227
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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 | 2012022415
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3487ATI
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License Number State | OR
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