Provider Demographics
NPI:1972566370
Name:GLICK-HANS, MARLA (OD)
Entity Type:Individual
Prefix:DR
First Name:MARLA
Middle Name:
Last Name:GLICK-HANS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2011
Mailing Address - Country:US
Mailing Address - Phone:516-817-2096
Mailing Address - Fax:516-817-2096
Practice Address - Street 1:328 N BROADWAY
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2011
Practice Address - Country:US
Practice Address - Phone:561-681-2020
Practice Address - Fax:516-681-2410
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0066571152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC313D1Medicare ID - Type Unspecified
U89669Medicare UPIN