Provider Demographics
NPI:1124341193
Name:ROBGLENN OPTICAL, INC.
Entity type:Organization
Organization Name:ROBGLENN OPTICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:REIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-771-3131
Mailing Address - Street 1:2253 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4746
Mailing Address - Country:US
Mailing Address - Phone:516-771-3131
Mailing Address - Fax:
Practice Address - Street 1:2253 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4746
Practice Address - Country:US
Practice Address - Phone:516-771-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003913152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100027177Medicare PIN
NY4172550001Medicare NSC