Provider Demographics
NPI:1538122593
Name:MCGARVEY, EUGENE J III (O D)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:J
Last Name:MCGARVEY
Suffix:III
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7747 W JEFFERSON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4135
Mailing Address - Country:US
Mailing Address - Phone:260-459-8444
Mailing Address - Fax:260-459-8443
Practice Address - Street 1:7747 W JEFFERSON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804
Practice Address - Country:US
Practice Address - Phone:260-459-8444
Practice Address - Fax:260-459-8443
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002781A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20090550Medicaid
IN160450011Medicare PIN
IN410034159Medicare PIN
IN402670AMedicare PIN
IN452570017Medicare PIN
IN669220AMedicare PIN
INM400037160Medicare PIN
IN296070AMedicare PIN
U09681Medicare UPIN
INP0035535Medicare PIN