Healthcare Provider Details

I. General information

NPI: 1932382363
Provider Name (Legal Business Name): SAMUEL D. GARRETT OD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MILLS AVE
GREENVILLE SC
29605-4020
US

IV. Provider business mailing address

210 MILLS AVE
GREENVILLE SC
29605-4020
US

V. Phone/Fax

Practice location:
  • Phone: 864-232-2779
  • Fax: 864-232-2779
Mailing address:
  • Phone: 864-232-2779
  • Fax: 864-232-2779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number712
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number714
License Number StateSC

VIII. Authorized Official

Name: DR. SAMUEL DAVID GARRETT
Title or Position: DOCTOR/OWNER
Credential: OD
Phone: 864-232-2779