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General NPI Number Information
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NPI Number | 1417032525
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Entity Type | Organization
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Legal Business Name | E.A. GUS GUTHRIE, O.D.P.C.
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 07/11/2007
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Provider Practice Location Address
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Address Line | 3720 N JOSEY LN 114
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City | CARROLLTON
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State | TX
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Zip | 75007-2481
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Country | US
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Telephone | 972-395-8434
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Fax | 972-395-8433
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Provider Business Mailing Address
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Address Line | 3720 N JOSEY LN 114
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City | CARROLLTON
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State | TX
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Zip | 75007-2481
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Country | US
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Telephone | 972-395-8434
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Fax | 972-395-8433
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KRYSTAL CARROLL
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Credential |
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Telephone | 972-395-8434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5216TG
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License Number State | TX
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