MEDICARE: DAVID L GUISELEY 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	OPT742	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000912	OTHER	ME	ANTHEM
2	1821106105	OTHER	ME	GROUP NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558378737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID L GUISELEY O.D.

Provider Business Mailing Address
First Line	:	PO BOX 1088
Second Line	:
City	:	GRAY
State	:	ME
Zip	:	04039-1088
Country	:	US
Telephone Number	:	207-657-4488
Fax Number	:	207-657-4574

Provider Business Practice Location Address
First Line	:	6 TURNPIKE ACRES RD
Second Line	:
City	:	GRAY
State	:	ME
Zip	:	04039-9432
Country	:	US
Telephone Number	:	207-657-4488
Fax Number	:	207-657-4574

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	05/26/2009

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