Provider Demographics
NPI:1023194818
Name:GUTOWSKI, ANATOLE FRANK
Entity type:Individual
Prefix:DR
First Name:ANATOLE
Middle Name:FRANK
Last Name:GUTOWSKI
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 1:159 MESCALERO TRL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-6089
Mailing Address - Country:US
Mailing Address - Phone:505-257-5029
Mailing Address - Fax:505-257-9096
Practice Address - Street 1:159 MESCALERO TRL
Practice Address - Street 2:SUITE 1
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6089
Practice Address - Country:US
Practice Address - Phone:505-257-5029
Practice Address - Fax:505-257-9096
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM333152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP0821Medicaid
NM410032284OtherRAILROAD MEDICARE
NMP420OtherBCBS
NM410032284OtherRAILROAD MEDICARE
NMP0821Medicaid