Provider Demographics
NPI:1578777637
Name:ARENOS, GLENN (OD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:ARENOS
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 1:20 VIA PINTO DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2755
Mailing Address - Country:US
Mailing Address - Phone:716-565-0261
Mailing Address - Fax:716-565-0264
Practice Address - Street 1:5033 TRANSIT ROAD
Practice Address - Street 2:WALMART VISION CENTER
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2755
Practice Address - Country:US
Practice Address - Phone:716-565-0261
Practice Address - Fax:716-565-0264
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0050791152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0279612734Medicare ID - Type Unspecified
U50694Medicare UPIN