Provider Demographics
NPI:1225130263
Name:J CRAIG GLADMAN O.D. P.A.
Entity Type:Organization
Organization Name:J CRAIG GLADMAN O.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:GLADMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD PA
Authorized Official - Phone:806-356-6868
Mailing Address - Street 1:3635 SONCY
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119
Mailing Address - Country:US
Mailing Address - Phone:806-356-6868
Mailing Address - Fax:806-351-0120
Practice Address - Street 1:3635 SONCY
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119
Practice Address - Country:US
Practice Address - Phone:806-356-6868
Practice Address - Fax:806-351-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03941TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0069PWOtherBCBS
TXT13458Medicare UPIN