Provider Demographics
NPI:1750519393
Name:GLENN A ALTMAN OD PA
Entity type:Organization
Organization Name:GLENN A ALTMAN OD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSDT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:941-351-2218
Mailing Address - Street 1:2936 UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2412
Mailing Address - Country:US
Mailing Address - Phone:941-351-2218
Mailing Address - Fax:941-359-8950
Practice Address - Street 1:2936 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2412
Practice Address - Country:US
Practice Address - Phone:941-351-2218
Practice Address - Fax:941-359-8950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2688152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1249270001Medicare NSC
FLDK456AMedicare PIN