Provider Demographics
NPI:1740232669
Name:ISAACSON, GLENN H (OD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:H
Last Name:ISAACSON
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 1:308 S FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2709
Mailing Address - Country:US
Mailing Address - Phone:509-662-1390
Mailing Address - Fax:509-663-9006
Practice Address - Street 1:1340 N WENATCHEE AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1558
Practice Address - Country:US
Practice Address - Phone:509-663-8868
Practice Address - Fax:509-663-9006
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001045152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2022036Medicaid
WA8857293Medicare ID - Type Unspecified
WA2022036Medicaid