Provider Demographics
NPI:1518085612
Name:GLICK, HENRY E (DO)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:E
Last Name:GLICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 CORAL HILLS DR
Mailing Address - Street 2:SUITE #206
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4137
Mailing Address - Country:US
Mailing Address - Phone:954-575-4711
Mailing Address - Fax:954-575-4722
Practice Address - Street 1:3100 CORAL HILLS DR
Practice Address - Street 2:SUITE #206
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4137
Practice Address - Country:US
Practice Address - Phone:954-575-4711
Practice Address - Fax:954-575-4722
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS8684207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1518085612OtherUNITED HEALTH CARE
FL1518085612OtherBLUE CROSS BLUE SHIELD
FL264000700Medicaid
FL1518085612OtherAVMED
FL1518085612OtherAETNA
FLK3740Medicare PIN
FLH68051Medicare UPIN