Provider Demographics
NPI:1891826996
Name:ANACLETO GUTIERREZ
Entity Type:Organization
Organization Name:ANACLETO GUTIERREZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANACLETO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD,MPH
Authorized Official - Phone:916-447-2020
Mailing Address - Street 1:2615 CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5904
Mailing Address - Country:US
Mailing Address - Phone:916-447-2020
Mailing Address - Fax:916-447-2910
Practice Address - Street 1:2615 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5904
Practice Address - Country:US
Practice Address - Phone:916-447-2020
Practice Address - Fax:916-447-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5532TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0747430001OtherDMERIC
CAGSD0015301Medicaid
CA152W00000XOtherTAXONOMIES
CA1710901004OtherINDIVIDUAL NPI
CASD0055320Medicaid
CASD0055320Medicaid
CA0747430001Medicare NSC
CA1710901004OtherINDIVIDUAL NPI
CA152W00000XOtherTAXONOMIES
CAMG0681177OtherMIDLEVEL DEA #