Provider Demographics
NPI:1841310745
Name:GUTIERREZ, MARIA F (OD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:F
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:F
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2505 AIRPORT THRUWAY
Mailing Address - Street 2:SUITE L
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9114
Mailing Address - Country:US
Mailing Address - Phone:706-221-1122
Mailing Address - Fax:
Practice Address - Street 1:2505 AIRPORT THRUWAY
Practice Address - Street 2:SUITE L
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9114
Practice Address - Country:US
Practice Address - Phone:706-221-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002356152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I411086Medicare PIN