Provider Demographics
NPI:1487644969
Name:GLASER, SCOTT A (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:GLASER
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 1:785 ROBERTS ST SW
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-2701
Mailing Address - Country:US
Mailing Address - Phone:320-587-7392
Mailing Address - Fax:
Practice Address - Street 1:225 MAIN ST S
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-2508
Practice Address - Country:US
Practice Address - Phone:320-587-2593
Practice Address - Fax:320-587-5852
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2775152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN692690800Medicaid
MN410001964Medicare ID - Type Unspecified
MN692690800Medicaid