MEDICARE: MRS. TAMARA GUTIERREZ O.D.

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	152WX0102X	Occupational Vision Optometrist	NV484	NV

General Provider Information

NPI Number	:	1396809927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMARA GUTIERREZ O.D.

Provider Business Mailing Address
First Line	:	2429 AMORETTI ST
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-5757
Country	:	US
Telephone Number	:	702-270-0926
Fax Number	:	702-270-0926

Provider Business Practice Location Address
First Line	:	3300 E FLAMINGO RD STE 20
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4398
Country	:	US
Telephone Number	:	702-434-9919
Fax Number	:	702-319-2156

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/08/2007

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