Provider Demographics
NPI:1245662071
Name:GUTMANN, CRYSTAL WU (OD)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:WU
Last Name:GUTMANN
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:1452 BRANDYWINE LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1126
Mailing Address - Country:US
Mailing Address - Phone:610-506-0249
Mailing Address - Fax:
Practice Address - Street 1:145 S 13TH ST STE 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4930
Practice Address - Country:US
Practice Address - Phone:215-922-3300
Practice Address - Fax:215-922-0775
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002789152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist