Provider Demographics
NPI:1326377151
Name:GLABE, DAVID KRISTOPHER (OD, MS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KRISTOPHER
Last Name:GLABE
Suffix:
Gender:M
Credentials:OD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 EMILY DR
Mailing Address - Street 2:
Mailing Address - City:ISLAND CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97850-8509
Mailing Address - Country:US
Mailing Address - Phone:402-430-2227
Mailing Address - Fax:
Practice Address - Street 1:1502 N PINE ST
Practice Address - Street 2:#3
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-3543
Practice Address - Country:US
Practice Address - Phone:541-963-3788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012022415152W00000X
OR3487ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist