MEDICARE: DR. GLEN A WHITEHEAD O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3096	OH
2	152WC0802X	Corneal and Contact Management Optometrist	3096	OH
3	152WP0200X	Pediatric Optometrist	3096	OH
4	152WS0006X	Sports Vision Optometrist	3096	OH
5	152WV0400X	Vision Therapy Optometrist	3096	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669578456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLEN A WHITEHEAD O.D.

Provider Business Mailing Address
First Line	:	2762 HERMAN RD
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45013-9533
Country	:	US
Telephone Number	:	513-892-5961
Fax Number	:	513-892-5962

Provider Business Practice Location Address
First Line	:	2762 HERMAN RD
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45013-9533
Country	:	US
Telephone Number	:	513-892-5961
Fax Number	:	513-892-5962

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	03/10/2008

Similar Medicare Providers

1205441581 — MR. JAMES A STOLZ
Practice Location Address:

2762 HERMAN RD
HAMILTON, OH
45013-9533

Practice Phone: 513-259-5955
Practice Fax:

1881295343 — AGAPE OHIO LLC
Practice Location Address:

2762 HERMAN RD
HAMILTON, OH
45013-9533

Practice Phone: 513-259-5955
Practice Fax:

1972389690 — MS. LOUISA TREINEN
Practice Location Address:

2762 HERMAN RD
HAMILTON, OH
45013-9533

Practice Phone: 513-259-1088
Practice Fax:

1780614909 — WEST MICHIGAN REHABILITATION PC
Practice Location Address:

3491 LINCOLN RD
HAMILTON, MI
49419-9533

Practice Phone: 269-751-2150
Practice Fax: 616-392-7959

1396131256 — KEITH SLENK PT, DPT, ATC
Practice Location Address:

3491 LINCOLN RD
HAMILTON, MI
49419-9533

Practice Phone: 269-751-2150
Practice Fax:

1437716990 — MEGAN FASICK
Practice Location Address:

2449 ROSS MILLVILLE RD STE 250
HAMILTON, OH
45013-8952

Practice Phone: 513-525-5092
Practice Fax: 513-525-1617

Directions to “ DR. GLEN A WHITEHEAD O.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.