Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 06670TPL | CA |
NPI | 1093857864 |
---|---|
Provider Name | Dr. Michael Anthony Glazeski |
First Address | Oakland, CA 94611-2556 |
Second Address | Alameda, CA 94501-4460 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 08/07/2007 |