Individual
DR. GLEN A WHITEHEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2762 HERMAN RD, HAMILTON, OH 45013-9533
(513) 892-5961
(513) 892-5962
Mailing address
2762 HERMAN RD, HAMILTON, OH 45013-9533
(513) 892-5961
(513) 892-5962
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3096
OH
152WC0802X
Corneal and Contact Management Optometrist
3096
OH
152WP0200X
Pediatric Optometrist
3096
OH
152WS0006X
Sports Vision Optometrist
3096
OH
152WV0400X
Vision Therapy Optometrist
3096
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0227007
—
OH
Enumeration date
09/16/2006
Last updated
03/10/2008
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