Provider Demographics
NPI:1508047408
Name:MICHAEL J GARNER OD PC
Entity Type:Organization
Organization Name:MICHAEL J GARNER OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:229-387-8863
Mailing Address - Street 1:PO BOX 72444
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-2444
Mailing Address - Country:US
Mailing Address - Phone:229-387-8863
Mailing Address - Fax:
Practice Address - Street 1:1830 HWY 82 W
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31793-8164
Practice Address - Country:US
Practice Address - Phone:229-387-8863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA816152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52157678-003OtherBCBS OF GA
GA52157678-003OtherBCBS OF GA
GAGRP7207Medicare PIN