Provider Demographics
NPI:1609898212
Name:GARRETT, JORGE ENRIQUE (OD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ENRIQUE
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 1:117 CIRCLE WAY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5233
Mailing Address - Country:US
Mailing Address - Phone:792-974-0429
Mailing Address - Fax:792-974-6869
Practice Address - Street 1:117 CIRCLE WAY ST
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5233
Practice Address - Country:US
Practice Address - Phone:979-297-4042
Practice Address - Fax:979-297-4686
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6159TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151803702Medicaid
TX8G7885Medicare PIN
TX151803702Medicaid