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General NPI Number Information
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NPI Number | 1629404777
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Entity Type | Individual
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Provider Name | JARED MARK GLACKEN O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2013
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Last Update Date | 07/10/2024
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Provider Practice Location Address
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Address Line | 125 S ANTRIM WAY
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City | GREENCASTLE
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State | PA
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Zip | 17225-1521
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Country | US
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Telephone | 717-597-4780
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Fax | 717-597-4755
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Provider Business Mailing Address
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Address Line | 8614 WESTWOOD CENTER DR FL 9
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City | VIENNA
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State | VA
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Zip | 22182-2442
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Country | US
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Telephone | 703-847-8899
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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 | TA2388
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License Number State | MD
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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 | OEG002801
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License Number State | PA
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