Provider Demographics
NPI:1477613081
Name:GLANVILLE & HUSSING, O.D., INC
Entity Type:Organization
Organization Name:GLANVILLE & HUSSING, O.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:GLANVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-929-9941
Mailing Address - Street 1:307 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2400
Mailing Address - Country:US
Mailing Address - Phone:330-673-7538
Mailing Address - Fax:330-673-0647
Practice Address - Street 1:307 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2400
Practice Address - Country:US
Practice Address - Phone:330-673-7538
Practice Address - Fax:330-673-0647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0361504Medicaid
OH0361504Medicaid