Provider Demographics
NPI:1609892611
Name:DONALD J GUIDO OD INC
Entity Type:Organization
Organization Name:DONALD J GUIDO OD INC
Other - Org Name:LA VERNE OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GUIDO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:909-593-3519
Mailing Address - Street 1:2248 D ST
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-5403
Mailing Address - Country:US
Mailing Address - Phone:909-593-3519
Mailing Address - Fax:909-593-3521
Practice Address - Street 1:2248 D ST
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-5403
Practice Address - Country:US
Practice Address - Phone:909-593-3519
Practice Address - Fax:909-593-3521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7205T261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1609892611Medicaid
CABN979ZMedicare PIN
CAWY8002AMedicare PIN
CA4947040001Medicare NSC