Provider Demographics
NPI:1598889792
Name:GLENN, DONNA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MARIE
Last Name:GLENN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:10627 TUPPENCE CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3929
Mailing Address - Country:US
Mailing Address - Phone:301-279-5838
Mailing Address - Fax:
Practice Address - Street 1:11301 ROCKVILLE PIKE
Practice Address - Street 2:LENSCRAFTERS
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1310152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist