Provider Demographics
NPI:1811181597
Name:MARCUS H. GLEATON
Entity type:Organization
Organization Name:MARCUS H. GLEATON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:H
Authorized Official - Last Name:GLEATON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-441-0010
Mailing Address - Street 1:119 S RANCH HOUSE RD
Mailing Address - Street 2:STE:200
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-2694
Mailing Address - Country:US
Mailing Address - Phone:817-441-0010
Mailing Address - Fax:817-441-0020
Practice Address - Street 1:119 S RANCH HOUSE RD
Practice Address - Street 2:STE:200
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-2694
Practice Address - Country:US
Practice Address - Phone:817-441-0010
Practice Address - Fax:817-441-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05905TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00226HMedicare PIN