=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619115714
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANTHONY J GENTILE OD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2009
-----------------------------------------------------
Last Update Date | 12/07/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10992 NW 7TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33168-2108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-754-2020
-----------------------------------------------------
Fax | 305-754-7352
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10992 NW 7TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33168-2108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-754-2020
-----------------------------------------------------
Fax | 305-754-7352
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANTHONY JAMES GENTILE
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 305-754-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC1583
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------