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NPI Code Detail

MEDICARE: DR. PHILIP EDWARDS GLANVILLE O.D.

MEDICARE: DR. PHILIP EDWARDS GLANVILLE O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist3119OH

General Provider Information

NPI Number : 1114069457
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PHILIP EDWARDS GLANVILLE O.D.
Provider Business Mailing Address
First Line : 6785 WALLINGS RD
Second Line :
City : NORTH ROYALTON
State : OH
Zip : 44133-3024
Country : US
Telephone Number : 440-237-9120
Fax Number : 440-237-9124
Provider Business Practice Location Address
First Line : 6785 WALLINGS RD
Second Line :
City : NORTH ROYALTON
State : OH
Zip : 44133-3024
Country : US
Telephone Number : 440-237-9120
Fax Number : 440-237-9124
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2007
Last Update Date : 07/08/2007

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