Individual
BRIAN R GUMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2123 W 6TH AVE, STILLWATER, OK 74074-4136
(405) 372-3724
(405) 743-1042
Mailing address
2123 W 6TH AVE, STILLWATER, OK 74074-4136
(405) 372-3724
(405) 743-1042
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1048
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0210790001
PALMETTO GOVERNMENT BENEFITS ADMINISTRATORS
OK
05
—
100766180A
—
OK
01
—
410033132
RAILROAD MEDICARE
OK
Enumeration date
06/10/2006
Last updated
09/05/2008
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