Provider Demographics
NPI:1396395497
Name:GUTIERREZ, IAN JAMES
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:JAMES
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 S HAMPTON RD STE 500
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-1654
Mailing Address - Country:US
Mailing Address - Phone:214-330-3937
Mailing Address - Fax:214-330-3939
Practice Address - Street 1:2301 S HAMPTON RD STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-1654
Practice Address - Country:US
Practice Address - Phone:214-330-3937
Practice Address - Fax:214-330-3939
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9845T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist