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Organization

MARC JAY GANNON OPTOMETRIST PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MARC JAY GANNON O.D. (DIRECTOR)
(954) 776-5223
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
152WL0500X
Low Vision Rehabilitation Optometrist
Primary
OPC1271
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
078390100
FL
Enumeration date
09/18/2008
Last updated
08/04/2009
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