Provider Demographics
NPI:1508932518
Name:DEMLINGER, GLENN MORRIS (OD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:MORRIS
Last Name:DEMLINGER
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:741 SHADOWRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-7997
Mailing Address - Country:US
Mailing Address - Phone:760-727-1844
Mailing Address - Fax:760-727-3044
Practice Address - Street 1:741 SHADOWRIDGE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-7997
Practice Address - Country:US
Practice Address - Phone:760-727-1844
Practice Address - Fax:760-727-3044
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2010-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA8954T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADA910AMedicare PIN