Provider Demographics
NPI:1538172267
Name:GLASS, JAMES RANDALL (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RANDALL
Last Name:GLASS
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 6986
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75505-6986
Mailing Address - Country:US
Mailing Address - Phone:903-794-3711
Mailing Address - Fax:903-794-3713
Practice Address - Street 1:4224 TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3013
Practice Address - Country:US
Practice Address - Phone:903-794-3711
Practice Address - Fax:903-794-3713
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6891T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX49979OtherAR BCBS
TX6891TOtherSTATE LICENSE
TX1538172267OtherNPI
TX81614QOtherTX BCBS
TX49979OtherAR BCBS