Provider Demographics
NPI:1679518757
Name:GUISTI, MARK LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEE
Last Name:GUISTI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2363 N 5TH ST
Mailing Address - Street 2:STE 106
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-4593
Mailing Address - Country:US
Mailing Address - Phone:775-738-3508
Mailing Address - Fax:775-738-4618
Practice Address - Street 1:2363 N 5TH ST
Practice Address - Street 2:STE 106
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-4593
Practice Address - Country:US
Practice Address - Phone:775-738-3508
Practice Address - Fax:775-738-4618
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV0700004503152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002504510Medicaid
NV410026356OtherRAILROAD MEDICARE
NV0805550001OtherCIGNA MEDICARE DMERC REGI
NV002504510Medicaid
NV0805550001OtherCIGNA MEDICARE DMERC REGI