Green, Glenn D

Green, Glenn D is an sole proprietor health care provider with primary practice located at 3882 N Foxtail Rd , Post Falls ID 83854-0264. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Green, Glenn D can be contacted via phone (360) 739-6887.

Contact Information

Primary practice address
3882 N Foxtail Rd Post Falls ID 83854-0264
Phone: (360) 739-6887
Fax: (208) 457-7008
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X OD00001910 Washington
Eye and Vision Services Providers / Optometrist 152W00000X ODP-100616 Idaho

Profile Details

NPI number 1598742827
LBN Legal business name Green, Glenn D
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 28th, 2005
Last updated Oct 15th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598742827 NPPES
Washington Other 03118 REGENCE OF WA
Washington Other 0078676 REGENCE OF WA
Washington MEDICAID 2022267 REGENCE OF WA
Washington Other 410040896 REGENCE OF WA
Washington Other 431510001 REGENCE OF WA

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