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NPI Code Detail

MEDICARE: JACQUELINE BROOKE GARRISON O.D.

MEDICARE: JACQUELINE BROOKE GARRISON 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
1152W00000XOptometrist18003895AIN

General Provider Information

NPI Number : 1578943445
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE BROOKE GARRISON O.D.
Provider Business Mailing Address
First Line : 2839 LAFAYETTE RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46222-2147
Country : US
Telephone Number : 317-924-1300
Fax Number : 855-326-4293
Provider Business Practice Location Address
First Line : 2839 LAFAYETTE RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46222-2147
Country : US
Telephone Number : 317-924-1300
Fax Number : 855-326-4293
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2015
Last Update Date : 05/08/2026

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