Provider Demographics
NPI:1578866240
Name:GLANVILLE EYE CARE LLC
Entity Type:Organization
Organization Name:GLANVILLE EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:KERN
Authorized Official - Last Name:GLANVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:608-827-0088
Mailing Address - Street 1:201 JUNCTION RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2615
Mailing Address - Country:US
Mailing Address - Phone:608-827-0088
Mailing Address - Fax:608-836-3895
Practice Address - Street 1:201 JUNCTION RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2615
Practice Address - Country:US
Practice Address - Phone:608-827-0088
Practice Address - Fax:608-836-3895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI 2923152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty