Provider Demographics
NPI:1932382363
Name:SAMUEL D. GARRETT OD, PA
Entity Type:Organization
Organization Name:SAMUEL D. GARRETT OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:864-232-2779
Mailing Address - Street 1:210 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4020
Mailing Address - Country:US
Mailing Address - Phone:864-232-2779
Mailing Address - Fax:864-232-2779
Practice Address - Street 1:210 MILLS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4020
Practice Address - Country:US
Practice Address - Phone:864-232-2779
Practice Address - Fax:864-232-2779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC712152W00000X
SC714332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC410023165OtherRAIL ROAD MEDICARE
SCCL3462OtherRAIL ROAD MEDICARE
SC0643360001OtherDMEPOS
SCT24184OtherUPIN
SC410023165OtherRAIL ROAD MEDICARE
SC4069Medicare PIN