Provider Demographics
NPI:1144460395
Name:GATDULA, VENERANDO TORRES (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:VENERANDO
Middle Name:TORRES
Last Name:GATDULA
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-1397 WAIPAHU ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3551
Mailing Address - Country:US
Mailing Address - Phone:808-469-7690
Mailing Address - Fax:
Practice Address - Street 1:94-260 WAIPAHU DEPOT ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3009
Practice Address - Country:US
Practice Address - Phone:808-469-7690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-01
Last Update Date:2009-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDIO-246156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician