Mark S Glenn, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

11533 Issued in KS

Practice address

702 N Kansas
Russell, KS 67665-0535

Phone

(785) 483-2451

Fax

(785) 483-4986

NPI assigned

Oct 5, 2006

Last updated

May 9, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ness City Eye Care, LLC.

  • Optometrist
  • Ness City, KS
  • NPI 1982009353
  NPD (past)

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462752000000",
    "number": "1689760886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 535",
            "city": "RUSSELL",
            "state": "KS",
            "postal_code": "676650535",
            "telephone_number": "785-483-2451",
            "fax_number": "785-483-4986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 N KANSAS",
            "city": "RUSSELL",
            "state": "KS",
            "postal_code": "676650535",
            "telephone_number": "785-483-2451",
            "fax_number": "785-483-4986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLENN",
        "first_name": "MARK",
        "middle_name": "S",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2016-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KS",
            "license": "11533",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMEPOS",
            "identifier": "5502690001",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100219210B",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eugene M. Davidson, D.C.P.a. (Davidson Chiropractic Health Center)
• Megan Annika Flavin
• Bernadette M Franks, LPC
• Morgan April Galliart, PA-C
• Carleen Kay Gilmore, ARNP
• Kiana Ann Grandclair
• Kylie Elizabeth Green
• Michele Louise Guiol
• Gary William Hainke I
• Haven Marlene Hamilton

• Optometrist in Russell, KS
• Providers in Russell, KS by specialty
• Optometrist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.