Provider Demographics
NPI:1649207978
Name:GIACOMO S GUGGINO MD PA
Entity Type:Organization
Organization Name:GIACOMO S GUGGINO MD PA
Other - Org Name:GUGGINO FAMILY EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIACOMO
Authorized Official - Middle Name:S
Authorized Official - Last Name:GUGGINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-879-7711
Mailing Address - Street 1:3115 W SWANN AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4617
Mailing Address - Country:US
Mailing Address - Phone:813-879-7711
Mailing Address - Fax:813-414-9189
Practice Address - Street 1:3115 W SWANN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4617
Practice Address - Country:US
Practice Address - Phone:813-879-7711
Practice Address - Fax:813-414-9189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0014464174400000X
FLME14464174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264735400Medicaid
FL21480Medicare PIN