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General NPI Number Information
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NPI Number | 1457762536
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Entity Type | Organization
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Legal Business Name | DR JOSEPH GLANDON LLC
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Dates
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Enumeration Date | 05/12/2014
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Last Update Date | 09/30/2014
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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 | 360-456-7869
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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 | 360-292-3112
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH GLANDON
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Credential | OD
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Telephone | 360-292-3112
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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 | 1287
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License Number State | WA
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