Provider Demographics
NPI:1366436917
Name:GUERRIERI, DENNIS J (OD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:J
Last Name:GUERRIERI
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 1:231 C ST
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4521
Mailing Address - Country:US
Mailing Address - Phone:530-758-4000
Mailing Address - Fax:530-758-4016
Practice Address - Street 1:231 C ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4521
Practice Address - Country:US
Practice Address - Phone:530-758-4000
Practice Address - Fax:530-758-4016
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8478T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0084781Medicaid
CA0634330001Medicare NSC
CASD0084781Medicaid
CASD0084781Medicare PIN