Provider Demographics
NPI:1871501783
Name:OELKER, GLENN F (MD)
Entity Type:Individual
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First Name:GLENN
Middle Name:F
Last Name:OELKER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:234 HEATHER CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-8765
Mailing Address - Country:US
Mailing Address - Phone:805-434-5970
Mailing Address - Fax:805-434-5973
Practice Address - Street 1:689 TANK FARM RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7077
Practice Address - Country:US
Practice Address - Phone:805-781-3937
Practice Address - Fax:805-781-9013
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-01-16
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Provider Licenses
StateLicense IDTaxonomies
CAG49598207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G495980Medicaid
A51410Medicare UPIN
CA00G495980Medicaid