Garrett William Elliott, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

35043 Issued in CA

Practice address

3601 Coffee Rd
Modesto, CA 95355-1161

Phone

(209) 521-1028

NPI assigned

Oct 13, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brian Edward Elliott, O.D.

  • Optometrist
  • Riverbank, CA
  • NPI 1760566434
  Medicare reassignment
• Modesto Optometric Vision Center Inc a Professional Optometric Corp

  • Optometrist
  • Modesto, CA
  • NPI 1891415410
  NPD
• Brian E. Elliott, O.D.

  • Optometrist
  • Riverbank, CA
  • NPI 1851528236
  NPD (past)
• L Edward Elliott Et Al PTR Elliott L Edward Gen PTR

  • Optometrist
  • Modesto, CA
  • NPI 1760558498
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634083200000",
    "number": "1427710706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7013 N PARK RIDGE CT",
            "city": "RIVERBANK",
            "state": "CA",
            "postal_code": "953679654",
            "telephone_number": "209-606-5167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551161",
            "telephone_number": "209-521-1028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "GARRETT",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-13",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "35043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roberta Margaret Elledge, LMFT
• Ashley Renee Ellenberger, NP
• David Garth Ellertson Sr., M.D.
• John Stephen Ellington, LCSW
• Alexis Elliott, BCBA
• Cody Ellis
• Desti A. Ellis, LCSW, CAS
• Katielyn Ellis
• Linda Lauray Ellis, RN, PHN
• Zachary Scott Ellis, CMT

• Optometrist in Modesto, CA
• Providers in Modesto, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.