Provider Demographics
NPI:1306896725
Name:GLICK, STEVEN LAWRENCE (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LAWRENCE
Last Name:GLICK
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 1:353 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4531
Mailing Address - Country:US
Mailing Address - Phone:303-377-3168
Mailing Address - Fax:
Practice Address - Street 1:1550 S POTOMAC ST
Practice Address - Street 2:155
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5455
Practice Address - Country:US
Practice Address - Phone:303-369-1020
Practice Address - Fax:303-369-1022
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1089152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08010894Medicaid
MG0016902OtherDEA
MG0016902OtherDEA
A0338Medicare ID - Type Unspecified