Provider Demographics
NPI:1033165147
Name:GAUDIO, RONALD J (OD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:GAUDIO
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 1:34 N SANDUSKY ST
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1902
Mailing Address - Country:US
Mailing Address - Phone:740-363-3377
Mailing Address - Fax:740-363-5559
Practice Address - Street 1:34 N SANDUSKY ST
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1902
Practice Address - Country:US
Practice Address - Phone:740-363-3377
Practice Address - Fax:740-363-5559
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3940152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000321640OtherANTHEM BC/BS
OH000000321640OtherANTHEM BC/BS