Individual provider Active NPI

Jason Glenn, O.D.

  • Optometrist
  • Lexington, KY
National Provider Identifier
1407995848
Registry record updated Jan 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1685DT Issued in KY
Practice address
124 Towne Center Drive
#116
Lexington, KY 40511
Phone
(859) 552-7403
NPI assigned
Feb 5, 2007
Last updated
Jan 16, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1685DT KY Primary

Addresses

Primary practice location

124 Towne Center Drive
#116
Lexington, KY 40511

Mailing address

124 Towne Center Drive
#116
Lexington, KY 40511
Phone (859) 552-7403

Other identifiers 2

IdentifierTypeStateIssuer
000000510977OtherKYANTHEM BCBS
7100030660MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20070530000365 KY Practitioner - Optometry 5799704359 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2005
Medicare assignment
May accept Medicare assignment
Group practices
Family First Vision Care Kentucky LLCGroup PAC ID 3577975291, 19 clinicians

Practice addresses (Care Compare)

105 Crossfield Dr
Versailles, KY 40383-1444
Phone (859) 879-3665

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Glenn Optical, PLLC Optometrist CurrentSince Jan 15, 2025 Accepting new patients
Family First Vision Care Kentucky, LLC Optometrist CurrentSince Aug 20, 2024 Accepting new patients
Ky Doctors of Optometry, PLLC Optometrist CurrentSince Mar 15, 2026 Accepting new patients
Charles G Pope Odpa Optometrist Past Accepting new patients
Chiro One Wellness Center of Meadowthorpe PLLC PastSince Aug 2, 2025 Accepting new patients
Ky Doctors of Optometry, PLLC Optometrist Past Accepting new patients

Locations

614 Buttermilk Pike
Crescent Springs, KY 41017
Phone (859) 320-0221

116 Towne Center Dr
Lexington, KY 40511
Phone (859) 226-0303

3735 Palomar Centre Dr
Lexington, KY 40513
Phone (859) 223-0701

3735 Palomar Centre Dr
Ste 170
Lexington, KY 40513
Phone (859) 271-2020

3801 Mall Rd
Ste 115
Lexington, KY 40503
Phone (859) 277-2020

105 Crossfield Dr
Versailles, KY 40383
Phone (859) 873-3665

316 S Hamilton Rd
Gahanna, OH 43230

Organizations & group practices 6

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": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1407995848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 TOWNE CENTER DRIVE",
            "address_2": "#116",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "40511",
            "telephone_number": "859-552-7403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 TOWNE CENTER DRIVE",
            "address_2": "#116",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "40511",
            "telephone_number": "859-552-7403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLENN",
        "first_name": "JASON",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1685DT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000510977",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100030660",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, KY

Sources for this page

Verify at the official NPI Registry.