Basic Information
| Provider Information | |||||||||
| NPI: | 1467421933 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLATT | ||||||||
| FirstName: | HERBERT | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1932 ALCOA HWY STE 255 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379201508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8652442030 | ||||||||
| FaxNumber: | 8656841196 | ||||||||
| Practice Location | |||||||||
| Address1: | 1932 ALCOA HWY STE 255 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379201508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8652442030 | ||||||||
| FaxNumber: | 8656841196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 01/31/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207WX0200X | MD0000019495 | TN | N | 207W00000X | 019495 | TN | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 0095809 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | 0840233 | 01 | UNITED HEALTHCARE | OTHER | 0640843 | 01 | CIGNA | OTHER | TN0108 | 01 | JOHN DEERE | OTHER | 0647640 | 01 | UMWA | OTHER | 180009851 | 01 | RAILROAD MEDICARE | OTHER | 100011734 | 01 | PHP | OTHER | 3047495 | 05 | TN | MEDICAID | 4600069 | 01 | AETNA | OTHER |