Provider Demographics
NPI:1386639490
Name:GLAZE, ROBERT V (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:V
Last Name:GLAZE
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:13401 BEL RED RD
Mailing Address - Street 2:STE A4
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2322
Mailing Address - Country:US
Mailing Address - Phone:425-747-2020
Mailing Address - Fax:425-747-2099
Practice Address - Street 1:13401 BEL RED RD
Practice Address - Street 2:STE A4
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2322
Practice Address - Country:US
Practice Address - Phone:425-747-2020
Practice Address - Fax:425-747-2099
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2007-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAWA1288152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGL0422OtherREGENE BLUE SHIELD
WAT60913Medicare UPIN