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General NPI Number Information
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NPI Number | 1831236827
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Entity Type | Organization
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Legal Business Name | S. GLENN BAILEY O.D., INC.
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 01/22/2010
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Provider Practice Location Address
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Address Line | 6010 US ROUTE 60 E
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City | BARBOURSVILLE
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State | WV
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Zip | 25504-1029
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Country | US
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Telephone | 304-733-0808
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Fax | 304-733-4234
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Provider Business Mailing Address
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Address Line | 6010 US ROUTE 60 E
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City | BARBOURSVILLE
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State | WV
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Zip | 25504-1029
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Country | US
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Telephone | 304-733-0808
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Fax | 304-733-4234
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN GLENN BAILEY
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Credential | O.D.
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Telephone | 304-733-0809
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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 | 717-OD
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License Number State | WV
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