Provider Demographics
NPI:1760474464
Name:GLASS, MARCIA (OD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:
Last Name:GLASS
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 1:1001 SW 2ND AVE
Mailing Address - Street 2:#4000
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-7245
Mailing Address - Country:US
Mailing Address - Phone:561-391-2362
Mailing Address - Fax:561-391-3012
Practice Address - Street 1:1001 SW 2ND AVE
Practice Address - Street 2:#4000
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-7245
Practice Address - Country:US
Practice Address - Phone:561-391-2362
Practice Address - Fax:561-391-3012
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1924152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19610ZMedicare PIN
FLT96174Medicare UPIN