1982764288 NPI number — GERALD W. GLASER, O.D. AND ASSOCIATES, INC.

Table of content: (NPI 1982764288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982764288 NPI number — GERALD W. GLASER, O.D. AND ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERALD W. GLASER, O.D. AND ASSOCIATES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982764288
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 BALD HILL RD
Provider Second Line Business Mailing Address:
SUITE 163
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02886-1617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-738-9866
Provider Business Mailing Address Fax Number:
401-732-7810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 BALD HILL RD
Provider Second Line Business Practice Location Address:
SUITE 163
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886-1617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-738-9866
Provider Business Practice Location Address Fax Number:
401-732-7810
Provider Enumeration Date:
12/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GLASER
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
401-738-9866

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  ODTA00466 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2200385 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: RI0466 . This is a "EYEMED VISION CARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 402684 . This is a "BLUE CHIP HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 7834-4 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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