MEDICARE: DR. GEORGE N GLOSIK 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
1	152W00000X	Optometrist	3653	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0284380001	OTHER	OH	MEDICARE DMEPOS
3	410011510	OTHER	OH	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000000132320	OTHER	OH	ANTHEM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457359036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE N GLOSIK O.D.

Provider Business Mailing Address
First Line	:	7305 BROADVIEW RD
Second Line	:
City	:	SEVEN HILLS
State	:	OH
Zip	:	44131-4442
Country	:	US
Telephone Number	:	216-642-7373
Fax Number	:	216-642-7383

Provider Business Practice Location Address
First Line	:	7305 BROADVIEW RD
Second Line	:
City	:	SEVEN HILLS
State	:	OH
Zip	:	44131-4442
Country	:	US
Telephone Number	:	216-642-7373
Fax Number	:	216-642-7383

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	06/17/2010

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