Provider Demographics
NPI:1215954706
Name:GARRETY, KAREN LISA (OD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LISA
Last Name:GARRETY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:GILMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 961
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93032-0961
Mailing Address - Country:US
Mailing Address - Phone:805-483-3616
Mailing Address - Fax:
Practice Address - Street 1:435 N A ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-4903
Practice Address - Country:US
Practice Address - Phone:805-483-3616
Practice Address - Fax:805-483-4377
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10029152W00000X
OR2421152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist