Provider Demographics
NPI:1336121003
Name:GLANZER, MARK JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAMES
Last Name:GLANZER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3900 E MEXICO AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3941
Mailing Address - Country:US
Mailing Address - Phone:303-800-2078
Mailing Address - Fax:303-800-2078
Practice Address - Street 1:2007 N JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2336
Practice Address - Country:US
Practice Address - Phone:903-572-6655
Practice Address - Fax:903-572-0213
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5400TG152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP087X1064Medicaid
TXC19436Medicare UPIN
TXP087X1064Medicaid
TX00R84ZMedicare PIN