Provider Demographics
NPI:1386762540
Name:GUTKOVICH ENTERPRISES, INC
Entity type:Organization
Organization Name:GUTKOVICH ENTERPRISES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD, MBA
Authorized Official - Phone:718-631-8211
Mailing Address - Street 1:24237A OAK PARK DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2624
Mailing Address - Country:US
Mailing Address - Phone:718-631-8211
Mailing Address - Fax:631-851-1688
Practice Address - Street 1:1850 VETERANS MEMORIAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749
Practice Address - Country:US
Practice Address - Phone:631-851-1564
Practice Address - Fax:631-851-1688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty