Provider Demographics
NPI:1760401848
Name:JOHN MICHAEL GARRETT MD PC
Entity Type:Organization
Organization Name:JOHN MICHAEL GARRETT MD PC
Other - Org Name:GARRETT EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-774-1404
Mailing Address - Street 1:1301 CARPENTER AVE
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-4725
Mailing Address - Country:US
Mailing Address - Phone:906-774-1404
Mailing Address - Fax:906-774-8132
Practice Address - Street 1:1301 CARPENTER AVE
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-4725
Practice Address - Country:US
Practice Address - Phone:906-774-1404
Practice Address - Fax:906-774-8132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003320152W00000X
WI2367-35152W00000X
MI4301040476174400000X
WI28873-20174400000X
207W00000X
MI13429261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI490000926Medicare PIN
MI0282300005Medicare NSC
MICM2566Medicare PIN
WI000040155Medicare PIN
MI180B27000Medicare ID - Type Unspecified
WI0282300004Medicare NSC
WICK5175Medicare PIN
MI0282300003Medicare NSC
MI0P41670Medicare PIN