MEDICARE: DR. RICHARD J GLAUBACH OD

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	T004125-1	NY

General Provider Information

NPI Number	:	1508896150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD J GLAUBACH OD

Provider Business Mailing Address
First Line	:	548 GREEN PL
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-1923
Country	:	US
Telephone Number	:	516-295-1345
Fax Number	:	718-523-7466

Provider Business Practice Location Address
First Line	:	13809 QUEENS BLVD
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11435-2641
Country	:	US
Telephone Number	:	718-739-6507
Fax Number	:	718-523-7466

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/08/2007

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