D Glen Joseph PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC 3971 Issued in FL

Legal business name

D GLEN JOSEPH PLLC

Practice address

12055 Pines Blvd
Pembroke Pines, FL 33026-4112

Phone

(954) 638-3139

Fax

(954) 431-0745

NPI assigned

Dec 3, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Darryl Glen Joseph, ODNPI 1033488085

Title

Owner

Phone

(561) 715-2737

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Darryl Glen Joseph, OD

  • Optometrist
  • Deerfield Beach, FL
  • NPI 1033488085
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1417564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417564800000",
    "number": "1851798078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21533 HALSTEAD DR",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334284844",
            "telephone_number": "561-715-2737",
            "fax_number": "954-431-0745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12055 PINES BLVD",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330264112",
            "telephone_number": "954-638-3139",
            "fax_number": "954-431-0745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D GLEN JOSEPH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-03",
        "last_updated": "2014-12-03",
        "status": "A",
        "authorized_official_last_name": "JOSEPH",
        "authorized_official_first_name": "DARRYL",
        "authorized_official_middle_name": "GLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "561-715-2737",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 3971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Pembroke Pines, FL
• Providers in Pembroke Pines, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.