Provider Demographics
NPI:1922204353
Name:GARRETTSON, BRYAN DAVIS I
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:DAVIS
Last Name:GARRETTSON
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 COHASSET RD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2201
Mailing Address - Country:US
Mailing Address - Phone:530-891-1600
Mailing Address - Fax:
Practice Address - Street 1:175 COHASSET RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2201
Practice Address - Country:US
Practice Address - Phone:530-891-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5269152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASDOO52691Medicare UPIN