Provider Demographics
NPI:1689894008
Name:ROBERT I GUDA OPT PA
Entity Type:Organization
Organization Name:ROBERT I GUDA OPT PA
Other - Org Name:PREMIER OPTICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:I
Authorized Official - Last Name:GUDA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:786-325-1027
Mailing Address - Street 1:6101 PINE RIDGE RD
Mailing Address - Street 2:PREMIER OPTICAL GROUP
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119
Mailing Address - Country:US
Mailing Address - Phone:239-348-4370
Mailing Address - Fax:239-348-4058
Practice Address - Street 1:6101 PINE RIDGE RD
Practice Address - Street 2:PREMIER OPTICAL GROUP
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119
Practice Address - Country:US
Practice Address - Phone:239-348-4370
Practice Address - Fax:239-348-4058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2805152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621208500Medicaid
FL621208500Medicaid
FL20753AMedicare ID - Type Unspecified