Provider Demographics
NPI:1881761088
Name:DRS. GUTOWSKI & SONNENMOSER
Entity type:Organization
Organization Name:DRS. GUTOWSKI & SONNENMOSER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANATOLE
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:GUTOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:575-461-4233
Mailing Address - Street 1:301 E ROUTE 66 BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401-3296
Mailing Address - Country:US
Mailing Address - Phone:575-461-4233
Mailing Address - Fax:575-461-4233
Practice Address - Street 1:301 E ROUTE 66 BLVD
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-3296
Practice Address - Country:US
Practice Address - Phone:575-461-4233
Practice Address - Fax:575-461-4233
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DRS. GUTOWSKI & SONNENMOSER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-30
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM337152W00000X
NM333152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM410032284OtherRAIL RAOD MEDICARE
NMP0821Medicaid
NME8076Medicaid
NME9156Medicaid
NM=========Medicare PIN
NM2590217Medicare PIN
NM410032284OtherRAIL RAOD MEDICARE
NME9156Medicaid