Individual provider Active NPI

Joseph W Glandon, O.D.

  • Optometrist
  • Lacey, WA
National Provider Identifier
1356457436
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1287TX Issued in WA
Practice address
1401 Galaxy Dr NE
Lacey, WA 98516-4746
Phone
(360) 456-7867
NPI assigned
Aug 22, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1287TX WA Primary

Addresses

Primary practice location

1401 Galaxy Dr NE
Lacey, WA 98516-4746

Mailing address

17034 173Rd LN SE
Rainier, WA 98576-9411
Phone (360) 446-1851

Other identifiers 1

IdentifierTypeStateIssuer
2062503MedicaidWA

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
I20081009000095 WA Practitioner - Optometry 1254409816 Reassigns benefits to 1 organization
Practice locations: Rainier, WA

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1401 Galaxy Dr NE
Lacey, WA 98516-4746
Phone (360) 456-7867

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1287TXWAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Dr Joseph Glandon LLC Optometrist CurrentSince Jun 10, 2013 Accepting new patients

Locations

1401 Galaxy Dr NE
Lacey, WA 98516
Phone (360) 456-7862

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356457436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17034 173RD LN SE",
            "city": "RAINIER",
            "state": "WA",
            "postal_code": "985769411",
            "telephone_number": "360-446-1851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 GALAXY DR NE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985164746",
            "telephone_number": "360-456-7867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLANDON",
        "first_name": "JOSEPH",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "1287TX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2062503",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lacey, WA

Sources for this page

Verify at the official NPI Registry.