Provider Demographics
NPI:1427137710
Name:GUARINO, DEREK WENTWORTH (OD)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:WENTWORTH
Last Name:GUARINO
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:PO BOX 912
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03821-0912
Mailing Address - Country:US
Mailing Address - Phone:603-742-0045
Mailing Address - Fax:603-742-0047
Practice Address - Street 1:113 NEW ROCHESTER RD
Practice Address - Street 2:SUITE ONE
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-8800
Practice Address - Country:US
Practice Address - Phone:603-742-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0706152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH09Y008473NH01OtherANTHEM
NHNH0706OtherEYEMED
NH9264211OtherCIGNA