Individual provider Active NPI

Susana Noemy Gutierrez, OD

  • Optometrist
  • Kingston, PA
National Provider Identifier
1881426443
Registry record updated Mar 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG004191 Issued in PA
Practice address
703 Rutter Ave
Kingston, PA 18704-4801
Phone
(570) 288-7405
NPI assigned
Aug 14, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OEG004191 PA Primary

Addresses

Primary practice location

703 Rutter Ave
Kingston, PA 18704-4801

Mailing address

2661 Riva Rd Ste 1030
Annapolis, MD 21401-7131
Phone (667) 354-5528

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240918002281 PA Practitioner - Optometry 7315488368 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

789 Airport Rd
Suite 105
Hazle Township, PA 18202-3294
Phone (570) 455-3391

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OEG004191PAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Vision Innovation Centers of Pennsylvania LLC Optometrist CurrentSince Aug 1, 2024 Accepting new patients
Vision Innovation Centers of Pennsylvania LLC Optometrist CurrentSince Aug 1, 2024 Accepting new patients
Vision Innovation Centers of Pennsylvania LLC Optometrist Past Accepting new patients

Locations

2661 Riva Rd
Ste 1030
Annapolis, MD 21401

126 W Front St
Berwick, PA 18603
Phone (570) 752-7458

789 Airport Rd
Ste 105
Hazle Township, PA 18202
Phone (570) 455-3391

703 Rutter Ave
Kingston, PA 18704
Phone (570) 288-7405

9 N Market St
Nanticoke, PA 18634
Phone (570) 735-3114

170 Boston Ave
West Pittston, PA 18643
Phone (570) 602-1010

Interoperability endpoints

  • Direct secure messaging: sgutierrez@vip.emadirect.md

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1723593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774137600000",
    "number": "1881426443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2661 RIVA RD STE 1030",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214017131",
            "telephone_number": "667-354-5528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 RUTTER AVE",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187044801",
            "telephone_number": "570-288-7405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUTIERREZ",
        "first_name": "SUSANA",
        "middle_name": "NOEMY",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-14",
        "last_updated": "2026-03-22",
        "certification_date": "2026-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG004191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingston, PA

Sources for this page

Verify at the official NPI Registry.