Individual
ROBERT SMITH GENTILE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1701 BOULEVARD SQ, STE C, WAYCROSS, GA 31501-8021
(912) 283-7171
(912) 284-9183
Mailing address
3024 N PATTERSON ST, VALDOSTA, GA 31602-1711
(229) 247-4114
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT001677
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115254692C
—
GA
05
—
115254692D
—
GA
Enumeration date
09/13/2005
Last updated
05/31/2017
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