Active NPI
Marie Elizabeth Gannon, O.D.
- Optometrist
- Fowlerville, MI
National Provider Identifier
1619996501
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901003277
- Practice address
- 970 Gehringer Dr
Fowlerville, MI 48836-8622 - Phone
- (517) 715-1002
- NPI assigned
- Jul 19, 2006
- Last updated
- Feb 5, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901003277 | MI | Primary |
Addresses
Primary practice location
970 Gehringer Dr
Fowlerville, MI 48836-8622
Mailing address
PO Box 463
Brighton, MI 48116-0463
Phone (248) 330-9478
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4901003277 | MI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brighton Optometry Services LLC | Optometrist | Current | Accepting new patients |
| Howell Vision Center, Inc. | Optometrist | Past | Accepting new patients |
Locations
970 Gehringer Dr
Fowlerville, MI 48836
Phone (517) 223-1106
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612483200000",
"number": "1619996501",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 463",
"city": "BRIGHTON",
"state": "MI",
"postal_code": "481160463",
"telephone_number": "248-330-9478"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "970 GEHRINGER DR",
"city": "FOWLERVILLE",
"state": "MI",
"postal_code": "488368622",
"telephone_number": "517-715-1002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANNON",
"first_name": "MARIE",
"middle_name": "ELIZABETH",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-19",
"last_updated": "2021-02-05",
"certification_date": "2021-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901003277",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fowlerville, MI
- Fowlerville Family Dentistry
- Fowlerville Medical Center, PLC
- Fowlerville RX LLC (Fowlerville Pharmacy)
- Fowlerville RX LLC (Fowlerville Pharmacy)
- Samantha Rose Franceschina
- Heather Diane Gilroy, RN, FNP-C
- Tom Lavern Hall II, OD
- Michael Paul Heidt, PHARMD
- Hannah Anne Henry, LPC
- Charles Thomas Hoffman, PHYSICAL THERAPIST
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.