Michelle A Gan, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT 12577 TPA Issued in CA

Practice address

9975 Carmel Mountain Rd
G6
San Diego, CA 92129-2800

Phone

(858) 780-9889

Fax

(858) 780-9876

NPI assigned

Jul 11, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Luxottica of America Inc

  • Eyewear Supplier
  • Kansas City, MO
  • NPI 1497412522
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424822400000",
    "number": "1730114711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9975 CARMEL MOUNTAIN RD",
            "address_2": "G6",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921292800",
            "telephone_number": "858-780-9889",
            "fax_number": "858-780-9876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9975 CARMEL MOUNTAIN RD",
            "address_2": "G6",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921292800",
            "telephone_number": "858-780-9889",
            "fax_number": "858-780-9876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAN",
        "first_name": "MICHELLE",
        "middle_name": "A",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-11",
        "last_updated": "2015-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT 12577 TPA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0125770",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Theresa Lynette Gamlin I, CLT, CMT
• Yomiyyu Zelalem Gammada, MD
• Jenna Gammill
• Genesis Salazar Gamoras
• Dana Gampel, O.D.
• Terence Gan, MD MPH
• Yam Gong Gan, D.M.D.
• Arielle Ganas, DDS
• Jose G Gancayco, RN
• Beatriz Gandara

• Optometrist in San Diego, CA
• Providers in San Diego, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.