Provider Demographics
NPI:1083885859
Name:COURTNEY, GLENN A (OPTICIAN ABOC)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:A
Last Name:COURTNEY
Suffix:
Gender:M
Credentials:OPTICIAN ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 S DUPONT HWY
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1757
Mailing Address - Country:US
Mailing Address - Phone:302-422-2800
Mailing Address - Fax:302-422-2882
Practice Address - Street 1:625 S DUPONT HWY
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4504
Practice Address - Country:US
Practice Address - Phone:302-678-3200
Practice Address - Fax:302-678-5914
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEN/A156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician