Individual
DR. GARY GENE SISSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2904 DIVISION STREET, ST JOSEPH, MI 49085
(269) 983-2020
(269) 983-3651
Mailing address
2904 DIVISION STREET, ST JOSEPH, MI 49085
(269) 983-2020
(269) 983-3651
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901002192
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900A165060
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
Enumeration date
02/09/2007
Last updated
06/26/2008
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