Provider Demographics
NPI:1215198809
Name:GLATTER-GOTZ, AIDA PROGRI (OD)
Entity Type:Individual
Prefix:DR
First Name:AIDA
Middle Name:PROGRI
Last Name:GLATTER-GOTZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AIDA
Other - Middle Name:
Other - Last Name:PROGRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 SE 17TH STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471
Mailing Address - Country:US
Mailing Address - Phone:352-732-7900
Mailing Address - Fax:352-732-7466
Practice Address - Street 1:150 SE 17TH STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-732-7900
Practice Address - Fax:352-732-7466
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC-4317152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018367200Medicaid