Provider Demographics
NPI:1881685220
Name:STRIBLING, GLEN H (OD)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:H
Last Name:STRIBLING
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 1:110 E GEORGETOWN ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39059-2746
Mailing Address - Country:US
Mailing Address - Phone:601-892-5053
Mailing Address - Fax:601-892-5741
Practice Address - Street 1:110 E GEORGETOWN ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39059-2746
Practice Address - Country:US
Practice Address - Phone:601-892-5053
Practice Address - Fax:601-892-5741
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS516152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087004Medicaid
MS410044093OtherMEDICARE RAILROAD
MS0276240002Medicare NSC
MS410044093OtherMEDICARE RAILROAD
MS00087004Medicaid