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General NPI Number Information
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NPI Number | 1366600082
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Entity Type | Organization
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Legal Business Name | PETER S. KLEM FRED P. GUARCELLO PTR
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 06/15/2011
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Provider Practice Location Address
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Address Line | 4028 DALE ROAD SUITE 102
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City | MODESTO
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State | CA
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Zip | 95356-9561
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Country | US
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Telephone | 209-527-7784
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Fax | 209-527-5079
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Provider Business Mailing Address
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Address Line | 4028 DALE ROAD SUITE 102
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City | MODESTO
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State | CA
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Zip | 95356-9561
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Country | US
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Telephone | 209-527-7784
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Fax | 209-527-5079
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Authorized Official
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Title or Position | PARTNER
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Name | DR. FRED PAUL GUARCELLO
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Credential | O.D.
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Telephone | 209-527-7784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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