Provider Demographics
NPI:1114069457
Name:GLANVILLE, PHILIP EDWARDS (OD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:EDWARDS
Last Name:GLANVILLE
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 1:6785 WALLINGS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-3024
Mailing Address - Country:US
Mailing Address - Phone:440-237-9120
Mailing Address - Fax:440-237-9124
Practice Address - Street 1:6785 WALLINGS RD
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-3024
Practice Address - Country:US
Practice Address - Phone:440-237-9120
Practice Address - Fax:440-237-9124
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3119152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0412752Medicare ID - Type Unspecified
OHT46470Medicare UPIN