Individual
MARK S GLENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
702 N KANSAS, RUSSELL, KS 67665-0535
(785) 483-2451
(785) 483-4986
Mailing address
PO BOX 535, RUSSELL, KS 67665-0535
(785) 483-2451
(785) 483-4986
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
11533
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100219210B
—
KS
01
—
5502690001
DMEPOS
KS
Enumeration date
10/05/2006
Last updated
05/09/2016
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