Individual
DR. GLENN D GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3882 N FOXTAIL RD, POST FALLS, ID 83854-0264
(360) 739-6887
(208) 457-7008
Mailing address
3882 N FOXTAIL RD, POST FALLS, ID 83854-0264
(360) 739-6887
(208) 457-7008
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OD00001910
WA
152W00000X
Optometrist
Primary
ODP-100616
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0078676
DEPT OF LABOR & INDUSTRIE
WA
01
—
03118
REGENCE OF WA
WA
05
—
2022267
—
WA
01
—
410040896
RAILROAD MEDICARE
WA
01
—
431510001
GROUP HEALTH
WA
Enumeration date
12/28/2005
Last updated
10/15/2024
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