Provider Demographics
NPI:1467417618
Name:H ROBERT GAETANO, O.D., INC
Entity Type:Organization
Organization Name:H ROBERT GAETANO, O.D., INC
Other - Org Name:VISION CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GAETANO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-792-4923
Mailing Address - Street 1:3155 CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-2880
Mailing Address - Country:US
Mailing Address - Phone:330-792-4923
Mailing Address - Fax:
Practice Address - Street 1:3155 CANFIELD RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-2880
Practice Address - Country:US
Practice Address - Phone:330-792-4923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0138309Medicaid
OH0138309Medicaid
0674350001Medicare NSC