# MARC JAY GANNON OPTOMETRIST PA

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194974782
- **Authorized official:** DR. MARC JAY GANNON O.D. (DIRECTOR)
- **Authorized official phone:** (954) 776-5223

## Contact information

- **Practice address:** 2021 E COMMERCIAL BLVD, 301, FORT LAUDERDALE, FL 33308-3763
- **Practice address phone:** (954) 776-5223
- **Practice address fax:** (954) 491-0027
- **Mailing address:** 2021 E COMMERCIAL BLVD, 301, FORT LAUDERDALE, FL 33308-3763
- **Mailing address phone:** (954) 776-5223
- **Mailing address fax:** (954) 491-0027

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152WL0500X | Low Vision Rehabilitation Optometrist | OPC1271 | FL | Yes |

## Other

- **Enumeration date:** 09/18/2008
- **Last updated:** 08/04/2009