Provider Demographics
NPI:1326342270
Name:MILES GLASSER, O.D., P.A.
Entity Type:Organization
Organization Name:MILES GLASSER, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MILES
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASSER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-472-7012
Mailing Address - Street 1:1705 WHITE HALL DR
Mailing Address - Street 2:204
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-6964
Mailing Address - Country:US
Mailing Address - Phone:954-472-7012
Mailing Address - Fax:
Practice Address - Street 1:1705 WHITE HALL DR
Practice Address - Street 2:204
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-6964
Practice Address - Country:US
Practice Address - Phone:954-472-7012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1273261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19295Medicare PIN