Provider Demographics
NPI:1962605220
Name:DRS. GUERRANT, INC.
Entity type:Organization
Organization Name:DRS. GUERRANT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:B
Authorized Official - Last Name:GUERRANT
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:888-497-2117
Mailing Address - Street 1:409 INDIAN MOUND DR
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1096
Mailing Address - Country:US
Mailing Address - Phone:888-497-2117
Mailing Address - Fax:859-497-2542
Practice Address - Street 1:409 INDIAN MOUND DR
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1096
Practice Address - Country:US
Practice Address - Phone:888-497-2117
Practice Address - Fax:859-497-2542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77012144Medicaid
U20782Medicare UPIN
KY3600Medicare PIN