Provider Demographics
NPI:1588990246
Name:GLASSMAN, GINA (OD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:GLASSMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:516 SCHOOLHOUSE RD.
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348
Mailing Address - Country:US
Mailing Address - Phone:610-444-9681
Mailing Address - Fax:
Practice Address - Street 1:516 SCHOOL HOUSE RD
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-1742
Practice Address - Country:US
Practice Address - Phone:610-444-9681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET008797152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist