Provider Demographics
NPI:1255460283
Name:GENTILE, ROBERT D (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:GENTILE
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 1:2241 CANYON VIEW GLN
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-5020
Mailing Address - Country:US
Mailing Address - Phone:760-744-5488
Mailing Address - Fax:
Practice Address - Street 1:732 CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-3535
Practice Address - Country:US
Practice Address - Phone:760-839-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6229TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist