Individual
DR. GLENN D ELLISOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1714 KINGWOOD DR, KINGWOOD, TX 77339-3046
(281) 359-2020
(281) 359-7019
Mailing address
2114 GOLDEN POND DR, KINGWOOD, TX 77345-1636
(281) 359-2020
(281) 359-7019
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
03337TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81071Q
BLUE CROSS
TX
Enumeration date
01/23/2007
Last updated
07/08/2007
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