Provider Demographics
NPI:1154583185
Name:GARRETT, MICHELLE A (OD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:A
Last Name:GARRETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 CUMBERLAND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965
Mailing Address - Country:US
Mailing Address - Phone:606-248-2549
Mailing Address - Fax:606-248-9188
Practice Address - Street 1:1403 CUMBERLAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965
Practice Address - Country:US
Practice Address - Phone:606-248-2549
Practice Address - Fax:606-248-9188
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2814152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1851505366OtherGROUP NPI
TN3945636OtherMEDICARE GROUP PTAN
TN3002693Medicare PIN
TN3945636OtherMEDICARE GROUP PTAN