Organization
PAUL J GLASS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL J GLASS (DIRECT OWNER)
(770) 491-0105
Entity
Organization
Contact information
Practice address
2163 NORTHLAKE PKWY, STE 102, TUCKER, GA 30084-4102
(770) 491-0105
(770) 934-6201
Mailing address
2163 NORTHLAKE PKWY, STE 102, TUCKER, GA 30084-4102
(770) 491-0105
(770) 934-6201
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
026278
GA
Other
Enumeration date
03/19/2008
Last updated
03/19/2008
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