Provider Demographics
NPI:1568751907
Name:DR. DONNA M. GLENN P.C.
Entity Type:Organization
Organization Name:DR. DONNA M. GLENN P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-881-4335
Mailing Address - Street 1:11301 ROCKVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1060
Mailing Address - Country:US
Mailing Address - Phone:301-881-4335
Mailing Address - Fax:301-881-1256
Practice Address - Street 1:11301 ROCKVILLE PIKE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1060
Practice Address - Country:US
Practice Address - Phone:301-881-4335
Practice Address - Fax:301-881-1256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1310152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty