1508828666 NPI number — DR. GLENN S CORBIN O.D.

Table of content: DR. GLENN S CORBIN O.D. (NPI 1508828666)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508828666 NPI number — DR. GLENN S CORBIN O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORBIN
Provider First Name:
GLENN
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508828666
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 BERKSHIRE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYOMISSING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19610-1219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-374-3134
Provider Business Mailing Address Fax Number:
610-374-0484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 BERKSHIRE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYOMISSING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19610-1219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-374-3134
Provider Business Practice Location Address Fax Number:
610-374-0484
Provider Enumeration Date:
04/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG00004 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01806401 . This is a "CAPITAL BLUE CROSS ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2144950 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 232211591 . This is a "BERKSHIRE HEALTH PARTNER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 29435/29436 . This is a "SPECTERA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 54384002 . This is a "DAVIS AFFINITY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: OEG000040 . This is a "HUMANA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0020591000 . This is a "INDEPENDENCE PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01806401 . This is a "KEYSTONE/SENIOR BLUE ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2206957 . This is a "SECURE HORIZON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: OEG000040 . This is a "LOOMIS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 385702 . This is a "HEALTHAMERICA/HEALTHASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 426448 . This is a "HIGHMARK BLUE SHIELD ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0020591000 . This is a "AMERIHEALTH PROVIDER ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01806401 . This is a "CAPITAL BLUE CROSS/KHPC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: NON PAR . This is a "NVA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: OEG000040 . This is a "CORESOURCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1508828666 . This is a "VSP/VISION SERVICE PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20861 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 410023367 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4589194 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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