Provider Demographics
NPI:1396754644
Name:GARRETT, CHARLES WALTER III (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WALTER
Last Name:GARRETT
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:6606 S YALE AVE
Mailing Address - Street 2:SUITE #205
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3364
Mailing Address - Country:US
Mailing Address - Phone:918-488-6608
Mailing Address - Fax:918-488-6609
Practice Address - Street 1:6606 S YALE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3364
Practice Address - Country:US
Practice Address - Phone:918-488-6608
Practice Address - Fax:918-488-6609
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2014-06-02
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Provider Licenses
StateLicense IDTaxonomies
OK17128207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100101670AMedicaid
OK180027938OtherRAILROAD MEDICARE
OK0004116209OtherAETNA
OK180027938OtherRAILROAD MEDICARE
OK0004116209OtherAETNA