Doctor Name: | GLENN R LONDOS |
NPI Number: | 1295791622 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | O.D. |
License Number: | 046007566 |
Business Practice Address: | 1103 E 31st St La Grange Park, IL - 605261280 |
Business Phone Number: | 7085881781 |
Business Fax Number: | |
Mailing Address: | 1234 Lathrop Ave, RIVER FOREST |
State: | IL |
Postal Code: | 603051116 |
Phone Number: | 7087715537 |
Fax Number: | |
NPI Enumeration Date: | 04/25/2006 |
NPI Last Update Date: | 09/27/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 152WC0802X |
License Number: | 046007566 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Optometrist |
Taxonomy Specialization: | Corneal and Contact Management |
Taxonomy Definition: | The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea |