Provider Demographics
NPI:1053511071
Name:DR. GLENN HIURA
Entity Type:Organization
Organization Name:DR. GLENN HIURA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HIURA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:661-947-2337
Mailing Address - Street 1:38433 20TH ST E
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4034
Mailing Address - Country:US
Mailing Address - Phone:661-947-2337
Mailing Address - Fax:661-947-4431
Practice Address - Street 1:38433 20TH ST E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4034
Practice Address - Country:US
Practice Address - Phone:661-947-2337
Practice Address - Fax:661-947-4431
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. GLENN HIURA, OPTOMETRIST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7489 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty