Provider Demographics
NPI:1457402547
Name:GLENESK, NEIL GEORGE (OD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:GEORGE
Last Name:GLENESK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1738 OLDE TOWNE RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-1427
Mailing Address - Country:US
Mailing Address - Phone:713-768-0565
Mailing Address - Fax:
Practice Address - Street 1:5109 LEESBURG PIKE
Practice Address - Street 2:STE 684
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-3215
Practice Address - Country:US
Practice Address - Phone:703-681-3152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3792TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist