Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | LDO000497 | GA |
NPI | 1184744997 |
---|---|
Provider Name | Hoyt Glaze |
First Address | Powder Springs, GA 30127-4915 |
Second Address | Marietta, GA 30060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 18/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1156400001 | CIGNA GOVERNMENT SERVICES (01) | GA |
1156400001 | MEDICARE NSC (01) | GA |
1348A | VISION CARE PLAN (01) | GA |
7704191393 | VISION SERVICE PLAN (01) | GA |
GA0497 | EYEMED (01) | GA |