MEDICARE: GUTHRIE MEDICAL GROUP PC

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

General Provider Information

NPI Number	:	1457064362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUTHRIE MEDICAL GROUP PC

Provider Business Mailing Address
First Line	:	1 GUTHRIE SQ
Second Line	:
City	:	SAYRE
State	:	PA
Zip	:	18840-1625
Country	:	US
Telephone Number	:	570-887-3090
Fax Number	:

Provider Business Practice Location Address
First Line	:	406 E 4TH ST
Second Line	:
City	:	WATKINS GLEN
State	:	NY
Zip	:	14891-1217
Country	:	US
Telephone Number	:	607-535-4842
Fax Number	:

Authorized Official
Title or Position	:	AVP CORPORATE REVENUE CYCLE
Name	:	BRENDA KELLEY
Credential	:
Telephone Number	:	570-887-3328

Provider Enumeration Date	:	01/05/2023
Last Update Date	:	01/05/2023

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