Individual
MR. GLENN B LYDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
3305 16TH AVE SE, SUITE 101, CONOVER, NC 28613-9213
(828) 994-4808
(828) 994-4809
Mailing address
3305 16TH AVE SE, SUITE 101, CONOVER, NC 28613-9213
(828) 994-4808
(828) 994-4809
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
—
—
224P00000X
Prosthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7795183
—
NC
Enumeration date
01/24/2007
Last updated
06/07/2016
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