Provider Demographics
NPI:1912905514
Name:GLOSIK, ROBERT J (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
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:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3606152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000132319OtherANTHEM
028438001OtherMEDICARE DMEPOS
OH0593451Medicaid
OH410011511OtherRR MEDICARE
028438001OtherMEDICARE DMEPOS
OHU02575Medicare UPIN
OH0284380001Medicare NSC
OH0561261Medicare PIN