Basic Information
| Provider Information | |||||||||
| NPI: | 1558414904 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUTHRIE | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1729 | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730701729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053213499 | ||||||||
| FaxNumber: | 4053645379 | ||||||||
| Practice Location | |||||||||
| Address1: | 13421 N PENNSYLVANIA AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731209008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057539006 | ||||||||
| FaxNumber: | 4057483193 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2007 | ||||||||
| LastUpdateDate: | 02/26/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 980 | OK | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.