=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215093596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | E. A. GUS GUTHRIE O.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2006
-----------------------------------------------------
Last Update Date | 01/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1948 CHISHOLM TRL
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75034-7678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-236-6211
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1948 CHISHOLM TRL
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75034-7678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-236-6211
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | EUGENE A. GUTHRIE
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 469-236-6211
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 05216TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------