Provider Demographics
NPI:1730150731
Name:GARRITY, THOMAS J (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:GARRITY
Suffix:
Gender:M
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:PO BOX 498
Mailing Address - Street 2:
Mailing Address - City:HOVEN
Mailing Address - State:SD
Mailing Address - Zip Code:57450-0498
Mailing Address - Country:US
Mailing Address - Phone:605-948-2269
Mailing Address - Fax:605-948-2260
Practice Address - Street 1:236 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HOVEN
Practice Address - State:SD
Practice Address - Zip Code:57450-0498
Practice Address - Country:US
Practice Address - Phone:605-948-2269
Practice Address - Fax:605-948-2260
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD136152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9201010Medicaid
SD9201013Medicaid
SD0100360OtherBCBS
SD9201010Medicaid
SD0100360OtherBCBS
SD9201013Medicaid