Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 1996 | AZ |
Y | 152W00000X | Optometrist | OPT33638TLG | CA |
NPI | 1013322122 |
---|---|
Provider Name | Jeffrey Michael Gless |
First Address | Vacaville, CA 95687-3908 |
Second Address | Vacaville, CA 95687-3908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2014 |
Last Update Date | 03/01/2022 |