Provider Demographics
NPI:1659447530
Name:GLISKER, RICHARD E (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:E
Last Name:GLISKER
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 INDIAN RIVER BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7700
Mailing Address - Country:US
Mailing Address - Phone:772-492-6977
Mailing Address - Fax:
Practice Address - Street 1:2101 INDIAN RIVER BLVD STE 106
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7700
Practice Address - Country:US
Practice Address - Phone:772-480-1781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2022-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4356332H00000X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115489600Medicaid
FL630062600Medicaid