Provider Demographics
NPI:1396809927
Name:GUTIERREZ, TAMARA (OD)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2429 AMORETTI ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5757
Mailing Address - Country:US
Mailing Address - Phone:702-270-0926
Mailing Address - Fax:702-270-0926
Practice Address - Street 1:3300 E FLAMINGO RD STE 20
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4398
Practice Address - Country:US
Practice Address - Phone:702-434-9919
Practice Address - Fax:702-319-2156
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV484152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV08418Medicare UPIN