Provider Demographics
NPI:1679752869
Name:GLANCE OPTIQUE, LTD
Entity Type:Organization
Organization Name:GLANCE OPTIQUE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRES
Authorized Official - Prefix:
Authorized Official - First Name:LENORE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRACEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-271-1000
Mailing Address - Street 1:7220 HERITAGE SQUARE DR
Mailing Address - Street 2:SUITE 560
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-5645
Mailing Address - Country:US
Mailing Address - Phone:574-271-1000
Mailing Address - Fax:574-271-9130
Practice Address - Street 1:7220 HERITAGE SQUARE DR
Practice Address - Street 2:SUITE 560
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-5645
Practice Address - Country:US
Practice Address - Phone:574-271-1000
Practice Address - Fax:574-271-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0111574072332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier