MEDICARE: DR. JORGE ENRIQUE GARRETT OD

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	6159TG	TX

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	:	1609898212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE ENRIQUE GARRETT OD

Provider Business Mailing Address
First Line	:	117 CIRCLE WAY ST
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5233
Country	:	US
Telephone Number	:	792-974-0429
Fax Number	:	792-974-6869

Provider Business Practice Location Address
First Line	:	117 CIRCLE WAY ST
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5233
Country	:	US
Telephone Number	:	979-297-4042
Fax Number	:	979-297-4686

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	01/22/2024

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