Provider Demographics
NPI:1982639852
Name:GLASSMAN, NANCY (OD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:GLASSMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5102 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2715
Mailing Address - Country:US
Mailing Address - Phone:718-492-7500
Mailing Address - Fax:718-492-6720
Practice Address - Street 1:5102 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2715
Practice Address - Country:US
Practice Address - Phone:718-492-7500
Practice Address - Fax:718-492-6720
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005740-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01781855Medicaid
NYU63316Medicare UPIN
NY01781855Medicaid