Provider Demographics
NPI:1457322737
Name:RICHARD GARRATT OD INC
Entity Type:Organization
Organization Name:RICHARD GARRATT OD INC
Other - Org Name:SAN DIMAS OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRATT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:909-599-1100
Mailing Address - Street 1:120 W BONITA AVE
Mailing Address - Street 2:STE A
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773
Mailing Address - Country:US
Mailing Address - Phone:909-599-1100
Mailing Address - Fax:909-394-1743
Practice Address - Street 1:120 W BONITA AVE
Practice Address - Street 2:STE A
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773
Practice Address - Country:US
Practice Address - Phone:909-599-1100
Practice Address - Fax:909-394-1743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8364T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0430950001OtherDMERC
CASD0083640Medicaid
CASD0083640Medicaid
CA0430950001OtherDMERC