Provider Demographics
NPI:1932758729
Name:GUERTIN, MELISSA A (RDO)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:A
Last Name:GUERTIN
Suffix:
Gender:F
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 OLD UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:MA
Mailing Address - Zip Code:01523-3029
Mailing Address - Country:US
Mailing Address - Phone:978-728-5445
Mailing Address - Fax:
Practice Address - Street 1:479 OLD UNION TPKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:MA
Practice Address - Zip Code:01523-3029
Practice Address - Country:US
Practice Address - Phone:978-537-3900
Practice Address - Fax:978-537-6030
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6728156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician