Provider Demographics
NPI:1205958030
Name:GLUCKSMAN, ALBERT M (OD)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:M
Last Name:GLUCKSMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:ALBERT
Other - Middle Name:M
Other - Last Name:GLUCKSMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1624 WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889
Mailing Address - Country:US
Mailing Address - Phone:401-739-1336
Mailing Address - Fax:401-732-2019
Practice Address - Street 1:1624 WARWICK AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889
Practice Address - Country:US
Practice Address - Phone:401-739-1336
Practice Address - Fax:401-732-2019
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTA00292152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI98128OtherBLUE CROSS
RI2200186OtherUHC
RI9009812Medicaid
RI2200186OtherUHC