Provider Demographics
NPI:1679518856
Name:PEARSON, GLYN M (OD)
Entity type:Individual
Prefix:
First Name:GLYN
Middle Name:M
Last Name:PEARSON
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 1:4405 GIOVANNI DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3879
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2601 PRESTON RD
Practice Address - Street 2:SUITE 2064
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9468
Practice Address - Country:US
Practice Address - Phone:972-377-0700
Practice Address - Fax:972-377-0719
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05311TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX040420403Medicaid
TX8A8840Medicare PIN
TX040420403Medicaid
TX8F8277Medicare PIN
TX8F8215Medicare PIN
TX8L2860Medicare PIN