NPI 1932412871 · live from the CMS NPI Registry
Jill M Bakota Gutierrez, O.D.
Optometrist in Fort Moore, GA. National Provider Identifier 1932412871, active.
NPI record
| NPI | 1932412871 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Optometrist 152W00000X |
| Practice location | Martin Army Community Hospital, 6600 Van Aalst Blvd, Bldg 9250, Fort Moore, GA 31905 |
| Practice phone | 762-408-3498 |
| Mailing address | Martin Army Community Hospital, 6600 Van Aalst Blvd, Bldg 9250, Ft Moore, GA 31905 |
| Enumerated | July 21, 2010 |
| Last updated | March 11, 2024 |
| Sole proprietor | No |
| Other names | Jill Bakota |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Optometrist | 152W00000X | 8634 TG (TX) |
| Optometrist primary | 152W00000X | OPT002625 (GA) |
| Optometrist | 152W00000X | 0002964 (CO) |
| Optometrist | 152W00000X | 046010341 (IL) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.