Provider Demographics
NPI:1043209448
Name:GARZA, KENNETH M (OD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:M
Last Name:GARZA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 HEDGCOXE RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-3104
Mailing Address - Country:US
Mailing Address - Phone:469-323-1927
Mailing Address - Fax:
Practice Address - Street 1:2100 HEDGCOXE RD
Practice Address - Street 2:SUITE 140
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-3104
Practice Address - Country:US
Practice Address - Phone:469-323-1927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05904TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00144950OtherRAILROAD MEDICARE
TX1043209448OtherPALMETTO GBA
TX143476302Medicaid
TX143476302Medicaid
TX8B7374Medicare PIN