Provider Demographics
NPI:1639252117
Name:SECOR, GLENDA BOTTOMS (OD)
Entity Type:Individual
Prefix:DR
First Name:GLENDA
Middle Name:BOTTOMS
Last Name:SECOR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17742 BEACH BLVD
Mailing Address - Street 2:# 305
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6853
Mailing Address - Country:US
Mailing Address - Phone:714-596-4488
Mailing Address - Fax:714-596-5522
Practice Address - Street 1:17742 BEACH BLVD # 305
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6853
Practice Address - Country:US
Practice Address - Phone:714-596-4488
Practice Address - Fax:714-596-5522
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA797T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADO710ZMedicare PIN