Provider Demographics
NPI:1326194606
Name:GUEVARA, MARTIN DENNIS (OD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:DENNIS
Last Name:GUEVARA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3524 TORRANCE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4821
Mailing Address - Country:US
Mailing Address - Phone:310-316-2055
Mailing Address - Fax:310-316-2058
Practice Address - Street 1:3524 TORRANCE BLVD
Practice Address - Street 2:STE 100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4821
Practice Address - Country:US
Practice Address - Phone:310-316-2055
Practice Address - Fax:310-316-2058
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7958T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T 95666Medicare UPIN
OP7958Medicare PIN
OP 7958Medicare ID - Type Unspecified
0214010001Medicare NSC