Provider Demographics
NPI:1700900701
Name:MATHENY, GLENN SCOTT (OD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:SCOTT
Last Name:MATHENY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:PISGAH FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:28768-0790
Mailing Address - Country:US
Mailing Address - Phone:828-884-9894
Mailing Address - Fax:
Practice Address - Street 1:3738 BATTLEGROUND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2344
Practice Address - Country:US
Practice Address - Phone:336-282-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC850152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC661290OtherUNITED HEALTH CARE
NC09547OtherBLUE CROSS BLUE SHIELD
NC48391OtherDAVIS
NC8909547Medicaid