Individual
MS. AMANDA LEE GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
495 CABOT ST STE 1, BEVERLY, MA 01915-2515
(978) 921-5000
(978) 921-5003
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5477
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/26/2021
Last updated
10/25/2023
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