Provider Demographics
NPI:1578131371
Name:GARVIN, LACEY LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:LACEY
Middle Name:LYNN
Last Name:GARVIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5621 VIEWPOINTE DR APT G
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-2634
Mailing Address - Country:US
Mailing Address - Phone:724-971-0582
Mailing Address - Fax:
Practice Address - Street 1:2929 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2463
Practice Address - Country:US
Practice Address - Phone:513-559-3599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006986152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist