Provider Demographics
NPI:1356878565
Name:GLASS, PEYTON (OD)
Entity type:Individual
Prefix:DR
First Name:PEYTON
Middle Name:
Last Name:GLASS
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 1:8907 WILSHIRE BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1930
Mailing Address - Country:US
Mailing Address - Phone:310-276-5333
Mailing Address - Fax:
Practice Address - Street 1:8907 WILSHIRE BLVD FL 3
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1930
Practice Address - Country:US
Practice Address - Phone:310-276-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33665152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist