Provider Demographics
NPI:1700966900
Name:GUADAGNO, ANTHONY JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:GUADAGNO
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 1:306 E US HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2654
Mailing Address - Country:US
Mailing Address - Phone:219-864-1300
Mailing Address - Fax:
Practice Address - Street 1:306 E US HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-2654
Practice Address - Country:US
Practice Address - Phone:219-864-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002630A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INGU010275OtherCLARITY VISION
IN000000249419OtherANTHEM/BCBS - ALL PLANS
IN200495500AMedicaid
IN24929OtherSPECTERA
IN9379793OtherPHCS
ININ2630OtherEYEMED
IN000000249419OtherANTHEM/BCBS - ALL PLANS
ININ2630OtherEYEMED
INU49386Medicare UPIN
IN000000249419OtherANTHEM/BCBS - ALL PLANS