Provider Demographics
NPI:1083830020
Name:GS GUGGINO
Entity Type:Organization
Organization Name:GS GUGGINO
Other - Org Name:GUGGINO FAMILY EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GS
Authorized Official - Middle Name:
Authorized Official - Last Name:GUGGINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-879-7711
Mailing Address - Street 1:3115 W SWANN AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4617
Mailing Address - Country:US
Mailing Address - Phone:813-879-7711
Mailing Address - Fax:
Practice Address - Street 1:3115 W SWANN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4617
Practice Address - Country:US
Practice Address - Phone:813-879-7711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUCCIAMO EYE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0014464332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053793400Medicaid
FL0915100001Medicare NSC