Individual
GLENN ALLAN VALLETTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5066 SE FEDERAL HWY, STUART, FL 34997-6627
(772) 286-0021
(772) 286-0021
Mailing address
5066 SE FEDERAL HWY, STUART, FL 34997-6627
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1710
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078258100
—
FL
Enumeration date
07/06/2006
Last updated
06/18/2009
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