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NPI Code Detail

MEDICARE: DR. ERIC RAFAEL GUZMAN O.D.

MEDICARE: DR. ERIC RAFAEL GUZMAN 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
1152W00000XOptometrist514PR

General Provider Information

NPI Number : 1356330385
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERIC RAFAEL GUZMAN O.D.
Provider Business Mailing Address
First Line : USA MEDDAC/ ATTN CREDENTIALS
Second Line : 11050 MT BELVEDERE BLVD
City : FORT DRUM
State : NY
Zip : 13602-4025
Country : US
Telephone Number : 315-772-4025
Fax Number : 315-772-9498
Provider Business Practice Location Address
First Line : USA MEDDAC/CREDENTIALS
Second Line : 11050 MT BELVEDERE BLVD
City : FORT DRUM
State : NY
Zip : 13602-5004
Country : US
Telephone Number : 315-772-4025
Fax Number : 315-772-9498
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2005
Last Update Date : 07/08/2007

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