Provider Demographics
NPI:1730253634
Name:GUZMAN, SERGIO A (OD)
Entity type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:A
Last Name:GUZMAN
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 1:1184 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-3424
Mailing Address - Country:US
Mailing Address - Phone:775-777-3937
Mailing Address - Fax:775-777-3334
Practice Address - Street 1:1184 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-3424
Practice Address - Country:US
Practice Address - Phone:775-777-3937
Practice Address - Fax:775-777-3334
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV322152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVU63118Medicare UPIN
NV33154Medicare ID - Type Unspecified