Individual
TRACEY MORETTE GLENDENNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D
Contact information
Practice address
201 RACINE DR, WILMINGTON, NC 28403-8702
(910) 395-6050
(910) 794-2222
Mailing address
1950 OLD GALLOWS RD, SUITE 520, VIENNA, VA 22182-3990
(703) 847-8899
(703) 991-0514
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1480
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0904G
BCBS PROV #
NC
01
—
410032676
RR MEDICARE INDIVIDUAL #
NC
01
—
410048231
RR MEDICARE INDIVIDUAL #
NC
05
—
890904G
—
NC
Enumeration date
04/11/2006
Last updated
11/15/2017
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