Provider Demographics
NPI:1558414904
Name:GUTHRIE, KENNETH W (OD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:W
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:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1729
Mailing Address - Country:US
Mailing Address - Phone:405-321-3499
Mailing Address - Fax:405-364-5379
Practice Address - Street 1:13421 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9008
Practice Address - Country:US
Practice Address - Phone:405-753-9006
Practice Address - Fax:405-748-3193
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK980152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist