Provider Demographics
NPI:1275771982
Name:JONATHAN G. GARRETSON, O.D., P.C.
Entity Type:Organization
Organization Name:JONATHAN G. GARRETSON, O.D., P.C.
Other - Org Name:PREMIER EYECARE & CONTACT LENS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:GARRETSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:248-241-6537
Mailing Address - Street 1:5724 CLARKSTON RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-3715
Mailing Address - Country:US
Mailing Address - Phone:248-241-6537
Mailing Address - Fax:248-241-6654
Practice Address - Street 1:5724 CLARKSTON RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-3715
Practice Address - Country:US
Practice Address - Phone:248-241-6537
Practice Address - Fax:248-241-6654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004259152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIV05322Medicare UPIN