Provider Demographics
NPI:1871636829
Name:GUALTIERI, ROD THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:ROD
Middle Name:THOMAS
Last Name:GUALTIERI
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 1:807 SNUFF MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807
Mailing Address - Country:US
Mailing Address - Phone:302-429-8860
Mailing Address - Fax:
Practice Address - Street 1:1067 W. BALTIMORE PIKE
Practice Address - Street 2:PEARL VISION GRANITE RUN MALL
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063
Practice Address - Country:US
Practice Address - Phone:610-566-7461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET 008785152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist