Provider Demographics
NPI:1700885969
Name:GLADNICK, ROBERT A (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:GLADNICK
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 1:1000 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1138
Mailing Address - Country:US
Mailing Address - Phone:215-368-1646
Mailing Address - Fax:215-368-8516
Practice Address - Street 1:1000 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1138
Practice Address - Country:US
Practice Address - Phone:215-368-1646
Practice Address - Fax:215-368-8516
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE007385T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U34578Medicare UPIN
PA090063LGRMedicare ID - Type Unspecified