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General NPI Number Information
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NPI Number | 1730238080
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Entity Type | Organization
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Legal Business Name | GLENN BAGGS, OD, PC
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | 501 N MAIN ST SUITE 36B
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City | MUSKOGEE
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State | OK
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Zip | 74401-6348
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Country | US
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Telephone | 918-687-9898
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Fax | 918-683-1990
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Provider Business Mailing Address
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Address Line | 501 N MAIN ST SUITE 36B
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City | MUSKOGEE
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State | OK
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Zip | 74401-6348
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Country | US
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Telephone | 918-687-9898
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Fax | 918-683-1990
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIC GLENN BAGGS
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Credential | O.D.
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Telephone | 918-687-9898
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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 | 2089
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License Number State | OK
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