Provider Demographics
NPI:1770535338
Name:GLASSBRENNER, WILLIAM MEADE (OD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MEADE
Last Name:GLASSBRENNER
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 1:2208 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1739
Mailing Address - Country:US
Mailing Address - Phone:308-382-7661
Mailing Address - Fax:308-381-8401
Practice Address - Street 1:2208 N WEBB RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1739
Practice Address - Country:US
Practice Address - Phone:308-382-7661
Practice Address - Fax:308-381-8401
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE779152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025074000Medicaid
278444Medicare ID - Type Unspecified
NET40321Medicare UPIN