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General NPI Number Information
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NPI Number | 1417078650
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Entity Type | Organization
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Legal Business Name | FRED P. GUARCELLO, O.D.
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1263 PLEASANT GROVE BLVD SUITE 100
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City | ROSEVILLE
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State | CA
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Zip | 95747-5858
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Country | US
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Telephone | 916-773-1195
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Fax | 916-773-1187
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Provider Business Mailing Address
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Address Line | 1263 PLEASANT GROVE BLVD SUITE 100
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City | ROSEVILLE
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State | CA
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Zip | 95747-5858
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Country | US
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Telephone | 916-773-1195
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Fax | 916-773-1187
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Authorized Official
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Title or Position | OWNER
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Name | FRED PAUL GUARCELLO
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Credential | O.D.
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Telephone | 916-773-1195
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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 | 6453T
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License Number State | CA
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