Provider Demographics
NPI:1356349930
Name:GEORGE N GLOSIK ROBERT J GLOSIK
Entity type:Organization
Organization Name:GEORGE N GLOSIK ROBERT J GLOSIK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:GLOSIK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:216-475-7373
Mailing Address - Street 1:7305 BROADVIEW RD.
Mailing Address - Street 2:
Mailing Address - City:SEVEN HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-4442
Mailing Address - Country:US
Mailing Address - Phone:216-642-7373
Mailing Address - Fax:216-642-7383
Practice Address - Street 1:7305 BROADVIEW RD.
Practice Address - Street 2:
Practice Address - City:SEVEN HILLS
Practice Address - State:OH
Practice Address - Zip Code:44131-4442
Practice Address - Country:US
Practice Address - Phone:216-642-7373
Practice Address - Fax:216-642-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0726932Medicaid
OH=========OtherWORKERS COMP
OH9923591Medicare PIN
OH0726932Medicaid