Provider Demographics
NPI:1396770855
Name:GLASSER, MILES J (OD)
Entity type:Individual
Prefix:DR
First Name:MILES
Middle Name:J
Last Name:GLASSER
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 1:1705 WHITE HALL DR APT 204
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-6912
Mailing Address - Country:US
Mailing Address - Phone:954-472-7012
Mailing Address - Fax:
Practice Address - Street 1:1705 WHITE HALL DR APT 204
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-6912
Practice Address - Country:US
Practice Address - Phone:954-472-7012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1273152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT54759Medicare UPIN
FL19295Medicare ID - Type Unspecified