Provider Demographics
NPI:1285662965
Name:GLASS, G. DANIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:G.
Middle Name:DANIEL
Last Name:GLASS
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 1:416 NEW KENT DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-6163
Mailing Address - Country:US
Mailing Address - Phone:610-436-4007
Mailing Address - Fax:
Practice Address - Street 1:3550 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-4128
Practice Address - Country:US
Practice Address - Phone:610-325-7787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000160152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA157528Medicare UPIN
PA0162000001Medicare NSC