Provider Demographics
NPI:1952314387
Name:GARN, DANIEL NYLE (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:NYLE
Last Name:GARN
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 1:2207 N MOLTER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-7571
Mailing Address - Country:US
Mailing Address - Phone:509-893-7574
Mailing Address - Fax:509-893-3703
Practice Address - Street 1:2207 N MOLTER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-7571
Practice Address - Country:US
Practice Address - Phone:509-893-7574
Practice Address - Fax:509-893-3703
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003833152W00000X
IDODP100041152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2028181Medicaid
WAGAB40227Medicare PIN
WA2028181Medicaid