Provider Demographics
NPI:1861552473
Name:GLANVILLE & HUSSING, O.D. , INC
Entity type:Organization
Organization Name:GLANVILLE & HUSSING, O.D. , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:GLANVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-929-9941
Mailing Address - Street 1:646 PORTAGE TRL
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-3000
Mailing Address - Country:US
Mailing Address - Phone:330-929-9941
Mailing Address - Fax:330-929-3926
Practice Address - Street 1:646 PORTAGE TRL
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3000
Practice Address - Country:US
Practice Address - Phone:330-929-9941
Practice Address - Fax:330-929-3926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2875152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0361504Medicaid
OHCH9930241Medicare ID - Type Unspecified