MEDICARE: DR. CHARLES WENDELL GURLEY II O.D.

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	1108	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245240217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES WENDELL GURLEY II O.D.

Provider Business Mailing Address
First Line	:	1433 ARLINGTON ST
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-2636
Country	:	US
Telephone Number	:	580-332-5606
Fax Number	:	580-332-3946

Provider Business Practice Location Address
First Line	:	1433 ARLINGTON ST
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-2636
Country	:	US
Telephone Number	:	580-332-5606
Fax Number	:	580-332-3946

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	03/07/2019

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