Provider Demographics
NPI:1912990276
Name:PATE, GLEN C (OD)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:C
Last Name:PATE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:4801 S CLIFF AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-7015
Mailing Address - Country:US
Mailing Address - Phone:816-478-1230
Mailing Address - Fax:816-478-4413
Practice Address - Street 1:9401 N OAK TRFY
Practice Address - Street 2:STE 200
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2233
Practice Address - Country:US
Practice Address - Phone:816-478-1230
Practice Address - Fax:816-478-4413
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2004017580152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00167226OtherRAILROAD MEDICARE
406D152Medicare PIN
P00167226OtherRAILROAD MEDICARE