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General NPI Number Information
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NPI Number | 1154827665
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Entity Type | Organization
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Legal Business Name | ANACLETO GUTIERREZ AN OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 04/03/2018
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Provider Practice Location Address
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Address Line | 2615 CAPITOL AVE
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City | SACRAMENTO
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State | CA
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Zip | 95816-5904
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Country | US
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Telephone | 916-447-2020
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Fax | 916-447-0270
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Provider Business Mailing Address
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Address Line | 2615 CAPITOL AVE
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City | SACRAMENTO
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State | CA
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Zip | 95816-5904
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Country | US
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Telephone | 916-447-2020
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Fax | 916-447-0270
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. ANACLETO GUTIERREZ
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Credential | O.D.
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Telephone | 916-447-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5532
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License Number State | CA
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