Provider Demographics
NPI:1336416577
Name:ROBERT S. GLASS, O.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ROBERT S. GLASS, O.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-574-0200
Mailing Address - Street 1:1696 NEWPORT BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3787
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1696 NEWPORT BLVD
Practice Address - Street 2:STE D
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3787
Practice Address - Country:US
Practice Address - Phone:949-547-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6447T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty