MARC JAY GANNON OPTOMETRIST PA NPI 1194974782

NPI Information

NPI: 1194974782
Provider Name: MARC JAY GANNON OPTOMETRIST PA
Classification: Optometrist - 152WL0500X
Entity Type: Organization

Specialization: Low Vision Rehabilitation

Address:
2021 E COMMERCIAL BLVD
301
FORT LAUDERDALE, FL
ZIP 33308
Phone: (954) 776-5223
Get Directions

MARC JAY GANNON OPTOMETRIST PA is a low vision rehabilitation optometrist in Fort Lauderdale, FL. The provider is optometrists who specialize in low-vision care having training to assess visual function, prescribe low-vision devices, develop treatment plans, and recommend other vision rehabilitation services. MARC JAY GANNON OPTOMETRIST PA NPI is 1194974782. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2021 E COMMERCIAL BLVD
301
FORT LAUDERDALE, FL
ZIP 33308-763
Phone: (954) 776-5223
Fax: (954) 491-0027

The provider's authorized official is Marc Jay Gannon .
The authorized official title is Director and has the following contact phone number (954) 776-5223.

The enumeration date for this NPI number is 9/18/2008 and was last updated on 8/4/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	152WL0500X	Optometrist	Low Vision Rehabilitation	OPC1271	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	T84099	MEDICARE UPIN
2	078390100	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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