Provider Demographics
NPI:1881690634
Name:MCGUIRE, DESMOND EDWARD (MD)
Entity Type:Individual
Prefix:MR
First Name:DESMOND
Middle Name:EDWARD
Last Name:MCGUIRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 N TUSTIN AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8689
Mailing Address - Country:US
Mailing Address - Phone:714-543-6020
Mailing Address - Fax:714-543-1720
Practice Address - Street 1:1401 N TUSTIN AVE
Practice Address - Street 2:STE 220
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8689
Practice Address - Country:US
Practice Address - Phone:714-543-6020
Practice Address - Fax:714-543-1720
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75183207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
201438714OtherCAL. OPTIONS
00A751830OtherCAL. OPTIONS
CAW17959Medicare ID - Type Unspecified
H39250Medicare UPIN