Provider Demographics
NPI:1598813800
Name:GARRATT, RICHARD (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:GARRATT
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 1:120 W BONITA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3085
Mailing Address - Country:US
Mailing Address - Phone:909-599-1100
Mailing Address - Fax:909-394-1743
Practice Address - Street 1:120 W BONITA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3085
Practice Address - Country:US
Practice Address - Phone:909-599-1100
Practice Address - Fax:909-394-1743
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 8364 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist