Provider Demographics
NPI:1689656589
Name:ALTMAN, GLENN ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ALAN
Last Name:ALTMAN
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 1:2936 UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2412
Mailing Address - Country:US
Mailing Address - Phone:941-351-2218
Mailing Address - Fax:941-359-8950
Practice Address - Street 1:2936 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2412
Practice Address - Country:US
Practice Address - Phone:941-351-2218
Practice Address - Fax:941-359-8950
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2688152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620318300Medicaid
U44649Medicare UPIN
FL20506Medicare PIN
1249270001Medicare NSC