Provider Demographics
NPI:1588640783
Name:DARLINGTON, GLENN DOUGLAS (OD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:DOUGLAS
Last Name:DARLINGTON
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 1:220 N MCKEMY AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2654
Mailing Address - Country:US
Mailing Address - Phone:480-961-1865
Mailing Address - Fax:480-785-0583
Practice Address - Street 1:2443 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-3375
Practice Address - Country:US
Practice Address - Phone:520-903-6462
Practice Address - Fax:520-903-6466
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2037152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ975680Medicaid
IL977130OtherIL GROUP MEDICARE
IL046008122Medicaid
U09602Medicare UPIN
AZZ174999Medicare PIN
ILL88341Medicare PIN
IL046008122Medicaid
AZZ175000Medicare PIN
AZZ175002Medicare PIN
AZ975680Medicaid
AZZ175003Medicare PIN