Provider Demographics
NPI:1619902996
Name:GAUDIO, JAMES JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOHN
Last Name:GAUDIO
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 1:6911 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1812
Mailing Address - Country:US
Mailing Address - Phone:718-458-5055
Mailing Address - Fax:718-458-8453
Practice Address - Street 1:6911 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1812
Practice Address - Country:US
Practice Address - Phone:718-458-5055
Practice Address - Fax:718-458-8453
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005179152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05922GMedicare PIN
NYU29390Medicare UPIN