Provider Demographics
NPI:1184761249
Name:GUERRA, LOUIS PETER (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:PETER
Last Name:GUERRA
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-9509
Mailing Address - Country:US
Mailing Address - Phone:212-744-1270
Mailing Address - Fax:212-737-0727
Practice Address - Street 1:1371 1 AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-9509
Practice Address - Country:US
Practice Address - Phone:212-744-1270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005496156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic