Provider Demographics
NPI:1851798078
Name:D GLEN JOSEPH PLLC
Entity Type:Organization
Organization Name:D GLEN JOSEPH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-715-2737
Mailing Address - Street 1:21533 HALSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4844
Mailing Address - Country:US
Mailing Address - Phone:561-715-2737
Mailing Address - Fax:954-431-0745
Practice Address - Street 1:12055 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-4112
Practice Address - Country:US
Practice Address - Phone:954-638-3139
Practice Address - Fax:954-431-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3971152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty