Provider Demographics
NPI:1861557696
Name:GLASSER, JAY (OD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:GLASSER
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 1:566 BROOKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5113
Mailing Address - Country:US
Mailing Address - Phone:407-291-1921
Mailing Address - Fax:407-297-8591
Practice Address - Street 1:9428 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-6800
Practice Address - Country:US
Practice Address - Phone:407-291-1921
Practice Address - Fax:407-297-8591
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1794152WX0102X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT84171Medicare UPIN
FL19935AMedicare ID - Type Unspecified