Healthcare Provider Details

I. General information

NPI: 1073568010
Provider Name (Legal Business Name): GLENN HAROLD HUGHES O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 03/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4452 EASTGATE BLVD SUITE 305
CINCINNATI OH
45245-1584
US

IV. Provider business mailing address

4452 EASTGATE BLVD SUITE 305
CINCINNATI OH
45245-1584
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-5700
  • Fax: 513-752-5716
Mailing address:
  • Phone: 513-752-5700
  • Fax: 513-752-5716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3418/T493
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1448DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: