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General NPI Number Information
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NPI Number | 1932288131
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Entity Type | Organization
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Legal Business Name | MICHAEL J GUILBERT, OD, PC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 01/28/2008
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Provider Practice Location Address
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Address Line | 88 CHARLES ST
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City | DEADWOOD
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State | SD
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Zip | 57732-1303
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Country | US
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Telephone | 605-578-1761
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Fax | 605-578-1121
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Provider Business Mailing Address
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Address Line | 88 CHARLES ST
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City | DEADWOOD
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State | SD
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Zip | 57732-1303
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Country | US
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Telephone | 605-578-1761
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Fax | 605-578-1121
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MICHAEL J. GUILBERT
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Credential | O.D.
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Telephone | 605-578-1761
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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 | 148
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License Number State | SD
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