Provider Demographics
NPI:1295878395
Name:GUISTI, RUSSELL (OD)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:GUISTI
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 1:2333 RENO HWY
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-6385
Mailing Address - Country:US
Mailing Address - Phone:775-428-6664
Mailing Address - Fax:775-428-6664
Practice Address - Street 1:2333 RENO HWY
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-6385
Practice Address - Country:US
Practice Address - Phone:775-428-6664
Practice Address - Fax:775-428-6664
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV123152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1295878395Medicaid
NV1295878395Medicare Oscar/Certification