Provider Demographics
NPI:1457359036
Name:GLOSIK, GEORGE N (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:N
Last Name:GLOSIK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7305 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SEVEN HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-4442
Mailing Address - Country:US
Mailing Address - Phone:216-642-7373
Mailing Address - Fax:216-642-7383
Practice Address - Street 1:7305 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:SEVEN HILLS
Practice Address - State:OH
Practice Address - Zip Code:44131-4442
Practice Address - Country:US
Practice Address - Phone:216-642-7373
Practice Address - Fax:216-642-7383
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3653152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0284380001OtherMEDICARE DMEPOS
OH000000132320OtherANTHEM
OH410011510OtherRR MEDICARE
OH0594487Medicaid
OH0594487Medicaid
OH0594487Medicaid
OH0284380001Medicare NSC
OHT48761Medicare UPIN