Provider Demographics
NPI:1568451664
Name:GUETTLER, DONNA M (OPTOMETRIST)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:GUETTLER
Suffix:
Gender:F
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 ALYCE LN
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1000
Mailing Address - Country:US
Mailing Address - Phone:803-327-3030
Mailing Address - Fax:803-327-3020
Practice Address - Street 1:1730 ALYCE LN
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1000
Practice Address - Country:US
Practice Address - Phone:803-327-3030
Practice Address - Fax:803-327-3020
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC899152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDO8999Medicaid
SCDO8999Medicaid
SC570902002Medicare PIN