Provider Demographics
NPI:1609519503
Name:GLICK, ABIGAIL (OD)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:GLICK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:ALMOMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:340 ALEXANDERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3644
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:340 ALEXANDERSVILLE RD
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3644
Practice Address - Country:US
Practice Address - Phone:937-866-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7043152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist