MEDICARE: H ROBERT GAETANO O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4106 T831	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235135807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	H ROBERT GAETANO O.D.

Provider Business Mailing Address
First Line	:	3155 CANFIELD RD
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44511-2880
Country	:	US
Telephone Number	:	330-792-4923
Fax Number	:	330-792-2382

Provider Business Practice Location Address
First Line	:	3155 CANFIELD RD
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44511-2880
Country	:	US
Telephone Number	:	330-792-4923
Fax Number	:	330-792-2382

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	01/27/2011

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