Provider Demographics
NPI:1205953759
Name:KENNETH W GUTHRIE OD INC
Entity type:Organization
Organization Name:KENNETH W GUTHRIE OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:GUTHRIE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-753-9006
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:405-749-3193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK980152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty