Provider Demographics
NPI:1417032038
Name:GUTHRIE, EUGENE A (OD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:A
Last Name:GUTHRIE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4180 TOWN CTR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-2567
Mailing Address - Country:US
Mailing Address - Phone:903-868-2020
Mailing Address - Fax:
Practice Address - Street 1:4180 TOWN CTR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-2567
Practice Address - Country:US
Practice Address - Phone:903-868-2020
Practice Address - Fax:903-813-1426
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5216TG152W00000X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometrist
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160229401Medicaid
TX160229401Medicaid
TX8A1426Medicare ID - Type UnspecifiedINDIVIDUAL ID