Individual
ANACLETO GUTIERREZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2615 CAPITOL AVE, SACRAMENTO, CA 95816-5904
(916) 447-2020
(916) 447-2910
Mailing address
2615 CAPITOL AVE, SACRAMENTO, CA 95816-5904
(916) 447-2020
(916) 447-2910
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5532TLG
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0747430001
DMERC SUPPLIER #
CA
01
—
GSD0015301
MEDI-CAL GROUP #
CA
05
—
SD0055320
—
CA
01
—
ZZZ17944Z
MEDICARE GROUP#
CA
Enumeration date
07/27/2006
Last updated
01/04/2017
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