Provider Demographics
NPI:1710982806
Name:SIT, GARRICK T (OD)
Entity Type:Individual
Prefix:
First Name:GARRICK
Middle Name:T
Last Name:SIT
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 1:324 S KALMIA STREET
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025
Mailing Address - Country:US
Mailing Address - Phone:760-741-7497
Mailing Address - Fax:760-741-7729
Practice Address - Street 1:324 S KALMIA STREET
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025
Practice Address - Country:US
Practice Address - Phone:760-741-7497
Practice Address - Fax:760-741-7729
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2007-12-26
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
CA10419T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4194050001OtherDMERC PROVIDER #
CA41068OtherCOLE MANAGED CARE
CA48609OtherSAFEGUARD DENTAL/VISION
CASD0104190Medicaid
CA917603OtherBLOCK VISION
CA117500OtherEYE MED VISION CARE
CA13450OtherMEDICAL EYE SERVICES PROV
CA13450OtherMEDICAL EYE SERVICES PROV
CA41068OtherCOLE MANAGED CARE