Provider Demographics
NPI:1922129295
Name:GLAZIERS LLC
Entity Type:Organization
Organization Name:GLAZIERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAINVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-643-6346
Mailing Address - Street 1:631 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5108
Mailing Address - Country:US
Mailing Address - Phone:860-643-6346
Mailing Address - Fax:860-643-7043
Practice Address - Street 1:631 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5108
Practice Address - Country:US
Practice Address - Phone:860-643-6346
Practice Address - Fax:860-643-7043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1170620001Medicare ID - Type Unspecified