Provider Demographics
NPI:1851323273
Name:GLANTZ, DANIEL SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:SCOTT
Last Name:GLANTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 STONERIDGE DR
Mailing Address - Street 2:SOUTH BUILDING, 1ST FLOOR
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-4501
Mailing Address - Country:US
Mailing Address - Phone:925-847-5065
Mailing Address - Fax:
Practice Address - Street 1:7601 STONERIDGE DR
Practice Address - Street 2:SOUTH BUILDING, FIRST FLOOR
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-4501
Practice Address - Country:US
Practice Address - Phone:925-847-5065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20763207W00000X
CAA053507207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150633Medicaid
OR150633Medicaid
G51072Medicare UPIN