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General NPI Number Information
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NPI Number | 1023194818
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Entity Type | Individual
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Provider Name | DR. ANATOLE FRANK GUTOWSKI
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Gender | Male
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 10/15/2012
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Provider Practice Location Address
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Address Line | 159 MESCALERO TRL SUITE 1
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City | RUIDOSO
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State | NM
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Zip | 88345-6089
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Country | US
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Telephone | 505-257-5029
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Fax | 505-257-9096
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Provider Business Mailing Address
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Address Line | 159 MESCALERO TRL SUITE 1
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City | RUIDOSO
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State | NM
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Zip | 88345-6089
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Country | US
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Telephone | 505-257-5029
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Fax | 505-257-9096
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number | 333
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License Number State | NM
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