Provider Demographics
NPI:1780656926
Name:NEVILLE, ROBERT GLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GLEN
Last Name:NEVILLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2865 N REYNOLDS RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-2068
Mailing Address - Country:US
Mailing Address - Phone:419-578-2020
Mailing Address - Fax:419-539-6323
Practice Address - Street 1:2865 N REYNOLDS RD
Practice Address - Street 2:SUITE 170
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2068
Practice Address - Country:US
Practice Address - Phone:419-578-2020
Practice Address - Fax:419-539-6323
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045233N207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH700691OtherFAMILY HEALTH PLAN
OH311550308OtherCIGNA
OH01661OtherPARAMOUNT
OH000000345023OtherANTHEM
OH4279100OtherAETNA
OH1183130002OtherADMINASTAR
OH0523393Medicaid
OH157805OtherUNITED HEALTHCARE
OH311550308OtherCIGNA
OH0529785Medicare PIN
OH000000345023OtherANTHEM
OH01661OtherPARAMOUNT