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General NPI Number Information
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NPI Number | 1356457436
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Entity Type | Individual
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Provider Name | JOSEPH W GLANDON O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1401 GALAXY DR NE
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City | LACEY
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State | WA
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Zip | 98516-4746
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Country | US
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Telephone | 360-456-7867
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Fax |
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Provider Business Mailing Address
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Address Line | 17034 173RD LN SE
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City | RAINIER
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State | WA
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Zip | 98576-9411
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Country | US
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Telephone | 360-446-1851
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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 | 1287TX
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License Number State | WA
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