Provider Demographics
NPI:1306158076
Name:GLOSE, JENNIFER MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:GLOSE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:GLOSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:8195 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6002
Mailing Address - Country:US
Mailing Address - Phone:716-631-3860
Mailing Address - Fax:716-276-3467
Practice Address - Street 1:7600 3RD AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-1842
Practice Address - Country:US
Practice Address - Phone:716-298-8182
Practice Address - Fax:716-298-0710
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007601152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist