MEDICARE: DR. LEE EDWARD GUERTIN III 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	MG0358033M (TPA)	MA
2	152W00000X	Optometrist	4074	MA

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
2	W16263	OTHER	MA	BCBS MASSACHUSETTS
3	152748	OTHER	MA	HARVARD PILGRIM
4	22-00849	OTHER	MA	UNITED HEALTH CARE
5	454708	OTHER	MA	TUFTS HEALTH PLAN
6	411983	OTHER	RI	BCBS RI BLUE CHIP
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	23640-7	OTHER	RI	BCBS RHODE ISLAND

General Provider Information

NPI Number	:	1326042995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE EDWARD GUERTIN III O.D.

Provider Business Mailing Address
First Line	:	86 PURGATORY RD
Second Line	:
City	:	SUTTON
State	:	MA
Zip	:	01590-2803
Country	:	US
Telephone Number	:	508-865-0696
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 COUNTY ST
Second Line	:
City	:	SOMERSET
State	:	MA
Zip	:	02726-4240
Country	:	US
Telephone Number	:	508-676-8167
Fax Number	:	508-676-1434

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	12/17/2021

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