MEDICARE: GLEN H STRIBLING OD

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	516	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	410044093	OTHER	MS	MEDICARE RAILROAD

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	:	1881685220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLEN H STRIBLING OD

Provider Business Mailing Address
First Line	:	110 E GEORGETOWN ST
Second Line	:
City	:	CRYSTAL SPRINGS
State	:	MS
Zip	:	39059-2746
Country	:	US
Telephone Number	:	601-892-5053
Fax Number	:	601-892-5741

Provider Business Practice Location Address
First Line	:	110 E GEORGETOWN ST
Second Line	:
City	:	CRYSTAL SPRINGS
State	:	MS
Zip	:	39059-2746
Country	:	US
Telephone Number	:	601-892-5053
Fax Number	:	601-892-5741

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	12/07/2023

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