Jill M Bakota Gutierrez, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT002625 Issued in GA

Practice address

Martin Army Community Hospital
6600 Van Aalst Blvd, BLDG 9250
Fort Moore, GA 31905

Phone

(762) 408-3498

NPI assigned

Jul 21, 2010

Last updated

Mar 11, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other names 1

• Dr. Jill M Bakota Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1279670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1932412871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MARTIN ARMY COMMUNITY HOSPITAL",
            "address_2": "6600 VAN AALST BLVD, BLDG 9250",
            "city": "FT MOORE",
            "state": "GA",
            "postal_code": "31905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MARTIN ARMY COMMUNITY HOSPITAL",
            "address_2": "6600 VAN AALST BLVD, BLDG 9250",
            "city": "FORT MOORE",
            "state": "GA",
            "postal_code": "31905",
            "telephone_number": "762-408-3498"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1512 3rd Ave",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "GA",
            "postal_code": "319011813",
            "country_code": "US",
            "telephone_number": "706-505-1018",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAKOTA GUTIERREZ",
        "first_name": "JILL",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-21",
        "last_updated": "2024-03-11",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "8634 TG",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002625",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "0002964",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046010341",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JILL",
            "last_name": "BAKOTA",
            "middle_name": "M",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jacob Allen
• Ildefonso G.D. Almonte, M.D.
• Kendra Anderson, DPM
• Kelly Avant, PT
• Hunter Leigh Bain, DO
• Lonnie Forrest Bambas
• Renita Lynn Barrett, LMSW
• Vanessa Bautista
• Megan Anne Benedict, PA-C
• Graeme Philip Bloomfield, MD

• Optometrist in Fort Moore, GA
• Providers in Fort Moore, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.