MEDICARE: DR. KELVIN LAMARK GARNER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1548-578	LA
2	152W00000X	Optometrist	7162T	TX

General Provider Information

NPI Number	:	1093907818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELVIN LAMARK GARNER O.D.

Provider Business Mailing Address
First Line	:	5914 SUMMERVILLE LN
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-5605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5914 SUMMERVILLE LN
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-5605
Country	:	US
Telephone Number	:	318-773-2100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2007
Last Update Date	:	12/30/2009

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