Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0801X | Contact Lens Fitter | 075117 | MD |
Y | 156FX1800X | Optician | 36730 | MD |
NPI | 1932472768 |
---|---|
Provider Name | Mr. Bruce Howard Glatt |
First Address | Eldersburg, MD 21784-8530 |
Second Address | Eldersburg, MD 21784-8530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2012 |
Last Update Date | 09/02/2012 |