Provider Demographics
NPI:1093934465
Name:GUERRIER, DONALD DEAN-RUSK (OD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:DEAN-RUSK
Last Name:GUERRIER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LINCOLN PL APT J
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-4034
Mailing Address - Country:US
Mailing Address - Phone:732-658-3382
Mailing Address - Fax:
Practice Address - Street 1:677 MT. PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104
Practice Address - Country:US
Practice Address - Phone:973-350-8224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA005529152W00000X
NYVUT005719152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY09107919Medicaid
NJ7508603Medicaid
NJ7508603Medicaid
NJ011825Medicare ID - Type Unspecified
NYC54631Medicare ID - Type Unspecified