Provider Demographics
NPI:1770617763
Name:GLASS, ROBERT S (OD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:GLASS
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 1:1696 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:949-574-0200
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:949-574-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6447T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist