MEDICARE: KENNETH W GUTHRIE OD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	980	OK

General Provider Information

NPI Number	:	1205953759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNETH W GUTHRIE OD INC

Provider Business Mailing Address
First Line	:	PO BOX 1729
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73070-1729
Country	:	US
Telephone Number	:	405-321-3499
Fax Number	:	405-364-5379

Provider Business Practice Location Address
First Line	:	13421 N PENNSYLVANIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-9008
Country	:	US
Telephone Number	:	405-753-9006
Fax Number	:	405-749-3193

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KENNETH W GUTHRIE
Credential	:	OD
Telephone Number	:	405-753-9006

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	02/26/2008

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