Provider Demographics
NPI:1144376500
Name:MCGUIRT, GARNETT RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:GARNETT
Middle Name:RICHARD
Last Name:MCGUIRT
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 1:4816 NELSON RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5214
Mailing Address - Country:US
Mailing Address - Phone:337-478-2020
Mailing Address - Fax:337-478-4206
Practice Address - Street 1:4816 NELSON RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5214
Practice Address - Country:US
Practice Address - Phone:337-478-2020
Practice Address - Fax:337-478-4206
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA897079T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAT19558Medicare UPIN
LA48411Medicare ID - Type UnspecifiedPROVIDER