Basic Information
| Provider Information | |||||||||
| NPI: | 1578779260 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARRETT | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | M.D., O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3835 N FREEWAY BLVD | ||||||||
| Address2: | 100 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958341928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165767900 | ||||||||
| FaxNumber: | 9162850338 | ||||||||
| Practice Location | |||||||||
| Address1: | 950 GLENN DR STE 235 | ||||||||
| Address2: | |||||||||
| City: | FOLSOM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956303193 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169909159 | ||||||||
| FaxNumber: | 9169884937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 03/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2002007094 | MO | N | Eye and Vision Services Providers | Optometrist | 207W00000X | 2002007094 | MO | N | Allopathic & Osteopathic Physicians | Ophthalmology | 2084P0800X | 45467 | KY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | A144630 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.