Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 8388T | TX |
NPI | 1013321918 |
---|---|
Provider Name | Nancy Lynette Gutierrez |
First Address | Vienna, VA 22182-3970 |
Second Address | Forney, TX 75126-8615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2014 |
Last Update Date | 28/10/2020 |