Healthcare Provider Details

I. General information

NPI: 1306871363
Provider Name (Legal Business Name): KERRY ANN GARWOOD O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 LAKE PLAZA DR SUITE 230
COLORADO SPRINGS CO
80906-3594
US

IV. Provider business mailing address

1130 LAKE PLAZA DR SUITE 230
COLORADO SPRINGS CO
80906-3594
US

V. Phone/Fax

Practice location:
  • Phone: 719-219-3819
  • Fax: 719-219-0411
Mailing address:
  • Phone: 719-219-3819
  • Fax: 719-219-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTUV006893
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA2089
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0002933
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: