Healthcare Provider Details

I. General information

NPI: 1093866840
Provider Name (Legal Business Name): ERIC S GUGLIELMO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 LEVIN RD NW STE 203
SILVERDALE WA
98383-7849
US

IV. Provider business mailing address

22232 17TH AVE SE STE 308
BOTHELL WA
98021-7425
US

V. Phone/Fax

Practice location:
  • Phone: 206-215-3850
  • Fax: 206-215-3870
Mailing address:
  • Phone: 425-296-3837
  • Fax: 206-215-3870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberMD60136200
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD60136200
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: