Provider Demographics
NPI:1528230125
Name:PHILIP E. GLANVILLE O.D.,INC.
Entity Type:Organization
Organization Name:PHILIP E. GLANVILLE O.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:EDWARDS
Authorized Official - Last Name:GLANVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-237-9120
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3119332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT46740Medicare UPIN
OH0683350001Medicare NSC