Provider Demographics
NPI:1780953174
Name:AGUILAR, GUADALUPE
Entity type:Individual
Prefix:MR
First Name:GUADALUPE
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W BROWN DEER RD
Mailing Address - Street 2:
Mailing Address - City:FOX POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53217-2372
Mailing Address - Country:US
Mailing Address - Phone:414-228-9873
Mailing Address - Fax:414-228-9841
Practice Address - Street 1:333 W BROWN DEER RD
Practice Address - Street 2:
Practice Address - City:FOX POINT
Practice Address - State:WI
Practice Address - Zip Code:53217-2372
Practice Address - Country:US
Practice Address - Phone:414-228-9873
Practice Address - Fax:414-228-9841
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician