Healthcare Provider Details

I. General information

NPI: 1912905514
Provider Name (Legal Business Name): ROBERT J GLOSIK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 BROADVIEW RD
SEVEN HILLS OH
44131-4442
US

IV. Provider business mailing address

7305 BROADVIEW RD
SEVEN HILLS OH
44131-4442
US

V. Phone/Fax

Practice location:
  • Phone: 216-642-7373
  • Fax: 216-642-7383
Mailing address:
  • Phone: 216-642-7373
  • Fax: 216-642-7383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3606
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: