Provider Demographics
NPI:1558541540
Name:STEPHEN L GLASSER OD, PC
Entity Type:Organization
Organization Name:STEPHEN L GLASSER OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:GLASSER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:202-223-3530
Mailing Address - Street 1:1050 17TH ST NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-5503
Mailing Address - Country:US
Mailing Address - Phone:202-223-3530
Mailing Address - Fax:202-223-9748
Practice Address - Street 1:1050 17TH ST NW
Practice Address - Street 2:SUITE 200
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-5503
Practice Address - Country:US
Practice Address - Phone:202-223-3530
Practice Address - Fax:202-223-9748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOP421152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0641350001Medicare UPIN