Individual
JASON GLENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
124 TOWNE CENTER DRIVE, #116, LEXINGTON, KY 40511
(859) 552-7403
Mailing address
124 TOWNE CENTER DRIVE, #116, LEXINGTON, KY 40511
(859) 552-7403
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1685DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000510977
ANTHEM BCBS
KY
05
—
7100030660
—
KY
Enumeration date
02/05/2007
Last updated
01/16/2025
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