Provider Demographics
NPI:1942424668
Name:EARL G GLOECKNER, M.D., LTD
Entity Type:Organization
Organization Name:EARL G GLOECKNER, M.D., LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:G
Authorized Official - Last Name:GLOECKNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-762-2333
Mailing Address - Street 1:1420 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-2916
Mailing Address - Country:US
Mailing Address - Phone:309-762-2333
Mailing Address - Fax:309-762-8001
Practice Address - Street 1:1420 7TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-2916
Practice Address - Country:US
Practice Address - Phone:309-762-2333
Practice Address - Fax:309-762-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08100437OtherBLUE CROSS BLUE SHIELD
IL0568080001Medicare NSC
A14601Medicare UPIN
IL210675Medicare ID - Type Unspecified