Glenn Gordon Deshaw, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2204TG Issued in TX

Practice address

2636 W Walnut St
Ste 200
Garland, TX 75042-6441

Phone

(972) 485-0700

Fax

(972) 485-0702

NPI assigned

Jun 16, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Allied Eye Associates, PC

  • Optometrist
  • Lewisville, TX
  • NPI 1093867376
  NPD (past)
• Buckner Vision, P.a.

  • Optometrist
  • Dallas, TX
  • NPI 1265752232
  NPD (past)

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311206400000",
    "number": "1346284643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2636 W WALNUT ST",
            "address_2": "STE 200",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750426441",
            "telephone_number": "972-485-0700",
            "fax_number": "972-485-0702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2636 W WALNUT ST",
            "address_2": "STE 200",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750426441",
            "telephone_number": "972-485-0700",
            "fax_number": "972-485-0702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESHAW",
        "first_name": "GLENN",
        "middle_name": "GORDON",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2011-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "2204TG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Deorian, FNP-C
• Dependable Care Health Service LLC
• Dependable Home Care, Inc.
• Cynthia G Derden, PHARM D
• Sentayhu Wendemu Desalegne
• Jonathan Glenn Deshaw, O.D.
• Debra A Desimone-Porter, LPC
• Destination Care
• Destiny Base Home Health Services, Inc
• Destiny First Home Health Care Inc

• Optometrist in Garland, TX
• Providers in Garland, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.