Provider Demographics
NPI:1245450675
Name:DAVIES, GLENN ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ALAN
Last Name:DAVIES
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 1:281 FAIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:EAST ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14445-1918
Mailing Address - Country:US
Mailing Address - Phone:585-248-5878
Mailing Address - Fax:
Practice Address - Street 1:500 KREAG RD
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3705
Practice Address - Country:US
Practice Address - Phone:585-249-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT003631152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist