MEDICARE: DR. KENNETH W GUTHRIE 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	980	OK

General Provider Information

NPI Number	:	1558414904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH W GUTHRIE O.D

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	:	405-748-3193

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	02/26/2008

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