Provider Demographics
NPI:1043495070
Name:AUGUSTUS GUARENTE OD
Entity Type:Organization
Organization Name:AUGUSTUS GUARENTE OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUSTUS
Authorized Official - Middle Name:
Authorized Official - Last Name:GUARENTE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:845-339-4990
Mailing Address - Street 1:240 LUCAS AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4316
Mailing Address - Country:US
Mailing Address - Phone:845-339-4990
Mailing Address - Fax:845-339-5001
Practice Address - Street 1:240 LUCAS AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4316
Practice Address - Country:US
Practice Address - Phone:845-339-4990
Practice Address - Fax:845-339-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD108OtherCDPHP