MEDICARE: DR. IAN JAMES GUTIERREZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	9845T	TX

General Provider Information

NPI Number	:	1396395497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IAN JAMES GUTIERREZ

Provider Business Mailing Address
First Line	:	2301 S HAMPTON RD STE 500
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-1654
Country	:	US
Telephone Number	:	214-330-3937
Fax Number	:	817-467-5819

Provider Business Practice Location Address
First Line	:	2301 S HAMPTON RD STE 500
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-1654
Country	:	US
Telephone Number	:	214-330-3937
Fax Number	:	817-467-5819

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2019
Last Update Date	:	05/07/2025

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