Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 673 | TN |
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 468 | MS |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 673 | TN |
NPI | 1073532693 |
---|---|
Provider Name | Dr. Glenn Goldring |
First Address | Senatobia, MS 38668-2138 |
Second Address | Senatobia, MS 38668-2138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 31/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00087885 | (05) | MS |
64-0616130 | HUMANA GOLD CHOICE (01) | MS |
T21021 | (02) | MS |