Provider Demographics
NPI:1619137239
Name:GARNER, ADAM T (OD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:T
Last Name:GARNER
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 1:215 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:IN
Mailing Address - Zip Code:46072-1911
Mailing Address - Country:US
Mailing Address - Phone:765-675-3937
Mailing Address - Fax:765-675-3938
Practice Address - Street 1:215 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IN
Practice Address - Zip Code:46072
Practice Address - Country:US
Practice Address - Phone:765-675-3937
Practice Address - Fax:765-675-3938
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003504A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200902760Medicaid
IN811310IMedicare PIN
IN160450VMedicare PIN
INP00706146Medicare PIN
INM400055065Medicare PIN
IN084190EMedicare PIN
IN452570006Medicare PIN
IN200902760Medicaid
INP00634091Medicare PIN