Healthcare Provider Details

I. General information

NPI: 1205953759
Provider Name (Legal Business Name): KENNETH W GUTHRIE OD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13421 N PENNSYLVANIA AVE
OKLAHOMA CITY OK
73120-9008
US

IV. Provider business mailing address

PO BOX 1729
NORMAN OK
73070-1729
US

V. Phone/Fax

Practice location:
  • Phone: 405-753-9006
  • Fax: 405-749-3193
Mailing address:
  • Phone: 405-321-3499
  • Fax: 405-364-5379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number980
License Number StateOK

VIII. Authorized Official

Name: KENNETH W GUTHRIE
Title or Position: PRESIDENT
Credential: OD
Phone: 405-753-9006