Provider Demographics
NPI:1669025425
Name:GUTOWSKI, DAVID ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:GUTOWSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:159 MESCALERO TRL STE 1
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-6089
Mailing Address - Country:US
Mailing Address - Phone:575-257-5029
Mailing Address - Fax:575-257-9096
Practice Address - Street 1:159 MESCALERO TRL STE 1
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6089
Practice Address - Country:US
Practice Address - Phone:575-257-5029
Practice Address - Fax:575-257-9096
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003525152W00000X
NV1022152W00000X
WAOD60970794152W00000X
OR4470152W00000X
NMOPT722152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist