Provider Demographics
NPI:1497431076
Name:GARRETT, KENDRICK LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:KENDRICK
Middle Name:LYNN
Last Name:GARRETT
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 1:4065 W 750 N
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:UT
Mailing Address - Zip Code:84015-7217
Mailing Address - Country:US
Mailing Address - Phone:801-682-3054
Mailing Address - Fax:
Practice Address - Street 1:1917 W 1800 N STE D1
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:UT
Practice Address - Zip Code:84015-8558
Practice Address - Country:US
Practice Address - Phone:801-896-2952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13447215-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist