Individual provider Active NPI

Jonathan Glennie, OD

  • Optometrist
  • Spokane, WA
National Provider Identifier
1184463101
Registry record updated Sep 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
61566550 Issued in WA
Practice address
521 W Garland Ave
Spokane, WA 99205-2954
Phone
(509) 327-9505
NPI assigned
May 20, 2024
Last updated
Sep 12, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 61566550 WA Primary

Addresses

Primary practice location

521 W Garland Ave
Spokane, WA 99205-2954

Mailing address

521 W Garland Ave
Spokane, WA 99205-2954
Phone (509) 327-9505

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240613003491 WA Practitioner - Optometry 5294278636 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeastern Washington EyecareGroup PAC ID 3870925092, 4 clinicians
Garland Vision Source IncGroup PAC ID 8123139425, 3 clinicians

Practice addresses (Care Compare)

102 S Oak St
Colville, WA 99114-2846
Phone (509) 684-5278

521 W Garland Ave
Spokane, WA 99205-2954
Phone (509) 327-9505

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery21

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
61566550WAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Northeastern Washington Eyecare Optometrist CurrentSince Aug 6, 2024 Accepting new patients
Garland Vision Source, Inc. Optometrist CurrentSince Jun 6, 2024 Accepting new patients

Locations

102 S Oak St
Colville, WA 99114
Phone (509) 684-5278

205 S Washington Ave
Newport, WA 99156
Phone (509) 447-2945

521 W Garland Ave
Spokane, WA 99205
Phone (509) 327-9505

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1716163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1184463101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 W GARLAND AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992052954",
            "telephone_number": "509-327-9505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 W GARLAND AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992052954",
            "telephone_number": "509-327-9505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLENNIE",
        "first_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-20",
        "last_updated": "2024-09-12",
        "certification_date": "2024-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "61566550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.