Provider Demographics
NPI:1932472768
Name:GLATT, BRUCE HOWARD (ABOC, NCLEC, FNAO)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:HOWARD
Last Name:GLATT
Suffix:
Gender:M
Credentials:ABOC, NCLEC, FNAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 RUSTLING LEAF CT
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-8530
Mailing Address - Country:US
Mailing Address - Phone:410-552-9799
Mailing Address - Fax:410-552-9798
Practice Address - Street 1:739 RUSTLING LEAF CT
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-8530
Practice Address - Country:US
Practice Address - Phone:410-552-9799
Practice Address - Fax:410-552-9798
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD075117156FC0801X
MD36730156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter