Provider Demographics
NPI:1033466024
Name:GARVIN, GEESALA (OD)
Entity Type:Individual
Prefix:
First Name:GEESALA
Middle Name:
Last Name:GARVIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3628 LOYOLA DRIVE
Mailing Address - Street 2:APT 348
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065
Mailing Address - Country:US
Mailing Address - Phone:251-767-2941
Mailing Address - Fax:
Practice Address - Street 1:3200 SEVERN AVE
Practice Address - Street 2:STE 102
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4793
Practice Address - Country:US
Practice Address - Phone:504-887-2020
Practice Address - Fax:504-887-7698
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1634-668T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist