Provider Demographics
NPI:1245336189
Name:GARRIDO, THOMAS S (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:S
Last Name:GARRIDO
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 1:5158 BLACK HAWK RD
Mailing Address - Street 2:E-1570, MCHB-PH-VCR (MAJ GARRIDO)
Mailing Address - City:GUNPOWDER
Mailing Address - State:MD
Mailing Address - Zip Code:21010-5403
Mailing Address - Country:US
Mailing Address - Phone:410-436-1006
Mailing Address - Fax:
Practice Address - Street 1:5158 BLACK HAWK RD
Practice Address - Street 2:E-1570, MCHB-PH-VCR (MAJ GARRIDO)
Practice Address - City:GUNPOWDER
Practice Address - State:MD
Practice Address - Zip Code:21010-5403
Practice Address - Country:US
Practice Address - Phone:410-436-1006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0419152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0419OtherNV STATE LICENSE
CA11565OtherCA STATE LICENSE
CAU82825Medicare UPIN
CASDO115650Medicare ID - Type Unspecified