Provider Demographics
NPI:1467754903
Name:W JOSEPH GARVIN OD OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:W JOSEPH GARVIN OD OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:760-743-2020
Mailing Address - Street 1:147 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-2701
Mailing Address - Country:US
Mailing Address - Phone:760-743-2020
Mailing Address - Fax:760-743-2517
Practice Address - Street 1:147 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-2701
Practice Address - Country:US
Practice Address - Phone:760-743-2020
Practice Address - Fax:760-743-2517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT6664TPL152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7108719Medicaid
CA7108719Medicaid
CAOP6664Medicare PIN
CAU19253Medicare PIN