Provider Demographics
NPI:1154383198
Name:GLADWELL, DAVID ARTHUR (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ARTHUR
Last Name:GLADWELL
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 1:412 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-0238
Mailing Address - Country:US
Mailing Address - Phone:540-586-9575
Mailing Address - Fax:540-586-0129
Practice Address - Street 1:412 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-0238
Practice Address - Country:US
Practice Address - Phone:540-586-9575
Practice Address - Fax:540-586-0129
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601000565152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009200509Medicaid
0497490001OtherADMINASTAR FEDERAL DMERC
870613318OtherPALMETTO GBA RR MEDICARE
0497490001OtherADMINASTAR FEDERAL DMERC
410000016Medicare ID - Type Unspecified