Individual
HOYT GLAZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LDO
Contact information
Practice address
653 CHEROKEE ST, MARIETTA, GA 30060
(770) 419-1393
(770) 419-8188
Mailing address
5245 LOCKWOOD LN, POWDER SPRINGS, GA 30127-4915
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
LDO000497
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1156400001
MEDICARE NSC
GA
01
—
1348A
VISION CARE PLAN
GA
01
—
7704191393
VISION SERVICE PLAN
GA
01
—
GA0497
EYEMED
GA
Enumeration date
03/29/2007
Last updated
03/18/2008
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