MEDICARE: DR. JOHN JOSEPH GARRITY III 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	4194-T055	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205820768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN JOSEPH GARRITY III O.D.

Provider Business Mailing Address
First Line	:	632 VINE ST
Second Line	:	STE 301
City	:	CINCINNATI
State	:	OH
Zip	:	45202-2425
Country	:	US
Telephone Number	:	513-621-0979
Fax Number	:	513-421-5345

Provider Business Practice Location Address
First Line	:	632 VINE ST
Second Line	:	STE 301
City	:	CINCINNATI
State	:	OH
Zip	:	45202-2425
Country	:	US
Telephone Number	:	513-621-0979
Fax Number	:	513-421-5345

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	09/21/2009

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