Individual
DR. GLENN C MIDDLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
11088 N US HWY 15 501 UNIT 925, ABERDEEN, NC 28315-2378
(910) 693-1226
(910) 692-8983
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1395
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0917R
BCBS PROVIDER #
NC
01
—
192431
MEDCOST
NC
01
—
410040072
RAILROAD MC PROVIDER #
NC
05
—
890917R
—
NC
01
—
FH700070
FIRST CAROLINA CARE
NC
Enumeration date
05/11/2006
Last updated
10/03/2022
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