Healthcare Provider Details

I. General information

NPI: 1780696021
Provider Name (Legal Business Name): ROBERT I GUDA OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROBERT I GUDA OPT PA OD

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6376 PINE RIDGE RD
NAPLES FL
34119-3908
US

IV. Provider business mailing address

6376 PINE RIDGE RD UNIT 170
NAPLES FL
34119-3927
US

V. Phone/Fax

Practice location:
  • Phone: 239-384-9905
  • Fax: 239-348-6975
Mailing address:
  • Phone: 239-384-9905
  • Fax: 239-384-6975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC2805FL
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: