Organization
GUTHRIE VISION SOURCE PC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL E. BENNETT O.D. (PRESIDENT)
(405) 282-4396
Entity
Organization
Contact information
Practice address
110 E HARRISON AVE, GUTHRIE, OK 73044-4839
(405) 282-4396
(405) 282-8298
Mailing address
110 E HARRISON AVE, GUTHRIE, OK 73044-4839
(405) 282-4396
(405) 282-8298
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
OK
332H00000X
Eyewear Supplier
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100759960A
—
OK
01
—
DC6377
RR MEDICARE
OK
Enumeration date
07/21/2006
Last updated
02/04/2008
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