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Individual

JEROME I GLAZER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
67 WELLS RD, WETHERSFIELD, CT 06109-3043
(860) 529-5429
(860) 563-5202
Mailing address
67 WELLS RD, WETHERSFIELD, CT 06109-3043
(860) 529-5429
(860) 563-5202

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
722
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
004023875
CT
01
00402387501
BLUECAREFAMILY MEDICAIDE
CT
01
060873845
CT TAX ID
CT
01
090000722CT01
ANTHEM BLUE CROSS
CT
01
112728
EYE MED
CT
01
13122
SPECTERA ID
CT
01
138028
WELLCARE OF CT MEDICARE
CT
01
17098
AVESIS
CT
01
773845
CONNECTICARE ID
CT
01
912918
BLOCK/MEDICAIDE
CT
01
C3E541
EMPIRE BLUE CROSS
CT
01
OV0193
HEALTH NET
CT
01
P386567
OXFORD
CT
Enumeration date
07/19/2006
Last updated
08/17/2009
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