Provider Demographics
NPI:1285644005
Name:GLEATON, MARCUS H (OD)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:H
Last Name:GLEATON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 S RANCH HOUSE RD
Mailing Address - Street 2:STE 1000
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-2694
Mailing Address - Country:US
Mailing Address - Phone:817-441-0010
Mailing Address - Fax:
Practice Address - Street 1:126 S RANCH HOUSE RD
Practice Address - Street 2:STE 1000
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-2694
Practice Address - Country:US
Practice Address - Phone:817-441-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05905TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00226HMedicare ID - Type Unspecified
TXU92074Medicare UPIN
TX4670490001Medicare NSC