Provider Demographics
NPI:1639139801
Name:GARNER, GREGORY L (OD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:L
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:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-0549
Mailing Address - Country:US
Mailing Address - Phone:260-569-9550
Mailing Address - Fax:260-569-0760
Practice Address - Street 1:833 N CASS ST
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-1613
Practice Address - Country:US
Practice Address - Phone:260-563-3672
Practice Address - Fax:260-563-6534
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001841A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100195990Medicaid
IN410037739Medicare PIN
INT35120Medicare UPIN
IN410037738Medicare PIN
IN160450002Medicare PIN
IN100195990Medicaid
IN084190CMedicare PIN