Provider Demographics
NPI:1124451968
Name:GLIVIC, ASHLEY JEAN (OD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:JEAN
Last Name:GLIVIC
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2191 21ST ST SW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34117-4607
Mailing Address - Country:US
Mailing Address - Phone:239-249-9931
Mailing Address - Fax:
Practice Address - Street 1:2191 21ST ST SW
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34117-4607
Practice Address - Country:US
Practice Address - Phone:239-249-9931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4828152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist