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General NPI Number Information
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NPI Number | 1326042995
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Entity Type | Individual
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Provider Name | LEE EDWARD GUERTIN III O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2005
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Last Update Date | 12/17/2021
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Provider Practice Location Address
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Address Line | 255 COUNTY ST
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City | SOMERSET
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State | MA
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Zip | 02726-4240
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Country | US
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Telephone | 508-676-8167
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Fax | 508-676-1434
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Provider Business Mailing Address
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Address Line | 86 PURGATORY RD
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City | SUTTON
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State | MA
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Zip | 01590-2803
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Country | US
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Telephone | 508-865-0696
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MG0358033M (TPA)
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4074
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License Number State | MA
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