Provider Demographics
NPI:1518943414
Name:GENTILE, ANTHONY JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JAMES
Last Name:GENTILE
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 1:10954 N.W. 7TH AVE.
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-2108
Mailing Address - Country:US
Mailing Address - Phone:561-542-9853
Mailing Address - Fax:305-754-2020
Practice Address - Street 1:10954 N.W. 7TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-2108
Practice Address - Country:US
Practice Address - Phone:305-754-2020
Practice Address - Fax:305-754-2020
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0001583152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20162OtherMEDICARE IDENTIFICATION NUMBER
FL078406100Medicaid