Provider Demographics
NPI:1467615336
Name:DR.PETER GUHL
Entity Type:Organization
Organization Name:DR.PETER GUHL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUHL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-890-2020
Mailing Address - Street 1:50 BROADSTREET ROAD
Mailing Address - Street 2:
Mailing Address - City:MANAKIN SABOT
Mailing Address - State:VA
Mailing Address - Zip Code:23103
Mailing Address - Country:US
Mailing Address - Phone:757-890-2020
Mailing Address - Fax:
Practice Address - Street 1:50 BROADSTREET ROAD
Practice Address - Street 2:
Practice Address - City:MANAKIN SABOT
Practice Address - State:VA
Practice Address - Zip Code:23103
Practice Address - Country:US
Practice Address - Phone:757-890-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000215152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009206655Medicaid
VA410001093Medicare UPIN