Provider Demographics
NPI:1396744983
Name:HATCHER, GLEN JR (DO)
Entity type:Individual
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First Name:GLEN
Middle Name:
Last Name:HATCHER
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:2598 WINDMILL PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5476
Mailing Address - Country:US
Mailing Address - Phone:702-896-6043
Mailing Address - Fax:702-896-9591
Practice Address - Street 1:9455 W RUSSELL RD
Practice Address - Street 2:100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5667
Practice Address - Country:US
Practice Address - Phone:702-896-6043
Practice Address - Fax:702-896-9591
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2015-12-21
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Provider Licenses
StateLicense IDTaxonomies
NV633207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0020-18787Medicaid
E25911Medicare UPIN
NVV105203Medicare PIN