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General NPI Number Information
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NPI Number | 1386762540
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Entity Type | Organization
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Legal Business Name | GUTKOVICH ENTERPRISES, INC
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1850 VETERANS MEMORIAL HIGHWAY
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City | ISLANDIA
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State | NY
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Zip | 11749
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Country | US
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Telephone | 631-851-1564
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Fax | 631-851-1688
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Provider Business Mailing Address
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Address Line | 24237A OAK PARK DR
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City | DOUGLASTON
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State | NY
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Zip | 11362-2624
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Country | US
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Telephone | 718-631-8211
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Fax | 631-851-1688
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. DMITRY GUTKOVICH
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Credential | O.D., M.B.A.
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Telephone | 718-631-8211
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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 |
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License Number State |
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