Provider Demographics
NPI:1467594572
Name:GLENN, GARY RAY (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:RAY
Last Name:GLENN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:925 BLOSSOM HILL RD STE 1139
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1243
Mailing Address - Country:US
Mailing Address - Phone:408-281-3381
Mailing Address - Fax:
Practice Address - Street 1:925 BLOSSOM HILL RD STE 1139
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1243
Practice Address - Country:US
Practice Address - Phone:408-281-3381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA9248T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management