Provider Demographics
NPI:1689859555
Name:LAU, GLENDY (OD)
Entity Type:Individual
Prefix:DR
First Name:GLENDY
Middle Name:
Last Name:LAU
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 1:2000 WESTVIEW BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3561
Mailing Address - Country:US
Mailing Address - Phone:936-756-3252
Mailing Address - Fax:
Practice Address - Street 1:2000 WESTVIEW BLVD STE A
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3561
Practice Address - Country:US
Practice Address - Phone:936-756-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5727152W00000X
TX7179T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist