Provider Demographics
NPI:1730134966
Name:GLENNIE, PETER WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:WILLIAM
Last Name:GLENNIE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1430 WILLAMETTE STREET #17
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4049
Mailing Address - Country:US
Mailing Address - Phone:541-762-2763
Mailing Address - Fax:541-434-0912
Practice Address - Street 1:1594 EDGEWATER STREET NW
Practice Address - Street 2:SUITE 190
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-4656
Practice Address - Country:US
Practice Address - Phone:503-779-2119
Practice Address - Fax:503-779-1195
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1903ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist