Provider Demographics
NPI:1558378737
Name:GUISELEY, DAVID L (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:GUISELEY
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:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-1088
Mailing Address - Country:US
Mailing Address - Phone:207-657-4488
Mailing Address - Fax:207-657-4574
Practice Address - Street 1:6 TURNPIKE ACRES RD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039-9432
Practice Address - Country:US
Practice Address - Phone:207-657-4488
Practice Address - Fax:207-657-4574
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT742152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000912OtherANTHEM
ME1821106105OtherGROUP NPI
ME161630099Medicaid
ME1821106105OtherGROUP NPI
ME134208862OtherGROUP EIN #
MET31390Medicare UPIN
ME6220150001Medicare NSC