Provider Demographics
NPI:1073568010
Name:HUGHES, GLENN HAROLD (OD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:HAROLD
Last Name:HUGHES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4452 EASTGATE BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1584
Mailing Address - Country:US
Mailing Address - Phone:513-752-5700
Mailing Address - Fax:513-752-5716
Practice Address - Street 1:4452 EASTGATE BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1584
Practice Address - Country:US
Practice Address - Phone:513-752-5700
Practice Address - Fax:513-752-5716
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3418/T493152W00000X
KY1448DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0401916Medicaid
KY77902757Medicaid
OH77901981Medicaid
OH77901999Medicaid
KY77540250Medicaid
KY0388408Medicare PIN
KY77902757Medicaid
OH0401916Medicaid
KY410033395Medicare PIN
OH0466083Medicare PIN
OH77901981Medicaid
KY77540250Medicaid
OH410037136Medicare PIN
OH0466082Medicare PIN