Provider Demographics
NPI:1649200270
Name:MINER, GLENN J (OD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:J
Last Name:MINER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6420 E LOWDEN RD
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-6128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1016 N 32ND ST
Practice Address - Street 2:STE. 2
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-5107
Practice Address - Country:US
Practice Address - Phone:602-267-7573
Practice Address - Fax:602-267-7595
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ491152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ20189547OtherTPIN
AZEGNU52050OtherMPIN