Provider Demographics
NPI:1821197641
Name:GUZEK-LATKA, CAMILLE MELANIE (OD)
Entity Type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:MELANIE
Last Name:GUZEK-LATKA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CAMILLE
Other - Middle Name:MELANIE
Other - Last Name:LATKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:113 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01013-1667
Mailing Address - Country:US
Mailing Address - Phone:413-592-7777
Mailing Address - Fax:413-592-9704
Practice Address - Street 1:113 CENTER ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-1667
Practice Address - Country:US
Practice Address - Phone:413-592-7777
Practice Address - Fax:413-592-9704
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3087152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0356484Medicaid
MA29538OtherHEALTH NEW ENGLAND
MAW15910OtherBLUE CROSS & BLUE SHIELD OF MASSACHUSETTS
MAW15910OtherBLUE CROSS & BLUE SHIELD OF MASSACHUSETTS
MA29538OtherHEALTH NEW ENGLAND