Provider Demographics
NPI:1093164147
Name:GUEDES, GIL (OD)
Entity Type:Individual
Prefix:
First Name:GIL
Middle Name:
Last Name:GUEDES
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 1:402 PREMIUM OUTLETS DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:OH
Mailing Address - Zip Code:45050-1832
Mailing Address - Country:US
Mailing Address - Phone:786-468-1272
Mailing Address - Fax:
Practice Address - Street 1:402 PREMIUM OUTLETS DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:OH
Practice Address - Zip Code:45050-1832
Practice Address - Country:US
Practice Address - Phone:786-468-1272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6459152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist