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General NPI Number Information
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NPI Number | 1831171743
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Entity Type | Individual
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Provider Name | VIKTORIYA GUTKEVICH O.D.
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Gender | Female
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Dates
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Enumeration Date | 11/16/2005
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Last Update Date | 11/22/2013
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Provider Practice Location Address
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Address Line | 48 GRAHAM AVE
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City | BROOKLYN
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State | NY
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Zip | 11206-4002
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Country | US
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Telephone | 718-388-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 105 KINGS HWY APT 3A
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City | BROOKLYN
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State | NY
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Zip | 11214-1525
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Country | US
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Telephone | 718-513-4052
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Fax |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV006614
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License Number State | NY
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