Active NPI
Glen A Whitehead, O.D.
- Optometrist
- Hamilton, OH
National Provider Identifier
1669578456
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3096
- Practice address
- 2762 Herman Rd
Hamilton, OH 45013-9533 - Phone
- (513) 892-5961
- Fax
- (513) 892-5962
- NPI assigned
- Sep 16, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3096 | OH | Primary |
| Corneal and Contact Management Optometrist | 152WC0802X | 3096 | OH | |
| Pediatric Optometrist | 152WP0200X | 3096 | OH | |
| Sports Vision Optometrist | 152WS0006X | 3096 | OH | |
| Vision Therapy Optometrist | 152WV0400X | 3096 | OH |
Addresses
Primary practice location
2762 Herman Rd
Hamilton, OH 45013-9533
Mailing address
2762 Herman Rd
Hamilton, OH 45013-9533
Phone (513) 892-5961
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0227007 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3096 | OH | MD | Pediatric Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205107200000",
"number": "1669578456",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2762 HERMAN RD",
"city": "HAMILTON",
"state": "OH",
"postal_code": "450139533",
"telephone_number": "513-892-5961",
"fax_number": "513-892-5962"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2762 HERMAN RD",
"city": "HAMILTON",
"state": "OH",
"postal_code": "450139533",
"telephone_number": "513-892-5961",
"fax_number": "513-892-5962"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITEHEAD",
"first_name": "GLEN",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-16",
"last_updated": "2008-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OH",
"license": "3096",
"primary": true
},
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "OH",
"license": "3096",
"primary": false
},
{
"code": "152WP0200X",
"taxonomy_group": "",
"desc": "Optometrist, Pediatrics",
"state": "OH",
"license": "3096",
"primary": false
},
{
"code": "152WS0006X",
"taxonomy_group": "",
"desc": "Optometrist, Sports Vision",
"state": "OH",
"license": "3096",
"primary": false
},
{
"code": "152WV0400X",
"taxonomy_group": "",
"desc": "Optometrist, Vision Therapy",
"state": "OH",
"license": "3096",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0227007",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hamilton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.