Provider Demographics
NPI:1326042995
Name:GUERTIN, LEE EDWARD III (OD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:EDWARD
Last Name:GUERTIN
Suffix:III
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 1:86 PURGATORY RD
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:MA
Mailing Address - Zip Code:01590-2803
Mailing Address - Country:US
Mailing Address - Phone:508-865-0696
Mailing Address - Fax:
Practice Address - Street 1:255 COUNTY ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02726-4240
Practice Address - Country:US
Practice Address - Phone:508-676-8167
Practice Address - Fax:508-676-1434
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMG0358033M (TPA)152W00000X
MA4074152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110024738AMedicaid
MAW16263OtherBCBS MASSACHUSETTS
MA152748OtherHARVARD PILGRIM
MA22-00849OtherUNITED HEALTH CARE
MA454708OtherTUFTS HEALTH PLAN
RI411983OtherBCBS RI BLUE CHIP
MA0702102Medicaid
RI23640-7OtherBCBS RHODE ISLAND
MAW17378Medicare ID - Type UnspecifiedMEDICARE