Provider Demographics
NPI:1679628721
Name:GLASNER, MURRAY DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:MURRAY
Middle Name:DAVID
Last Name:GLASNER
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 1:6 CHELSEA CT
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2704
Mailing Address - Country:US
Mailing Address - Phone:203-775-8141
Mailing Address - Fax:
Practice Address - Street 1:1 OLD PARK LANE RD
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2507
Practice Address - Country:US
Practice Address - Phone:860-355-2655
Practice Address - Fax:860-355-2656
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT601152W00000X, 152WV0400X
CT0601152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT23247Medicare UPIN