Marc Jay Gannon, O.D.

Primary specialty

Low Vision Rehabilitation OptometristTaxonomy code 152WL0500X

License

OPC001271 Issued in FL

Practice address

2021 E Commercial Blvd
Suite #301
Ft Lauderdale, FL 33308-3763

Phone

(954) 776-5223

Fax

(954) 491-0027

NPI assigned

Sep 20, 2005

Reactivated

Apr 18, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 1976

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Marc Jay Gannon Optometrist PA

  • Low Vision Rehabilitation Optometrist
  • Fort Lauderdale, FL
  • NPI 1194974782
  Medicare reassignment NPD Authorized official
• A James Segal MD PA Medeyeassociates

  • Ophthalmology Physician
  • South Miami, FL
  • NPI 1710907522
  Medicare reassignment
• Miramar Vision Center

  • Corneal and Contact Management Optometrist
  • Miramar, FL
  • NPI 1225574783
  NPD (past)

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196121600000",
    "number": "1841286424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2021 E COMMERCIAL BLVD",
            "address_2": "SUITE #301",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333083763",
            "telephone_number": "954-776-5223",
            "fax_number": "954-491-0027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 E COMMERCIAL BLVD",
            "address_2": "SUITE #301",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333083763",
            "telephone_number": "954-776-5223",
            "fax_number": "954-491-0027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANNON",
        "first_name": "MARC",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2007-11-27",
        "deactivation_date": "2006-03-24",
        "reactivation_date": "2006-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "FL",
            "license": "OPC001271",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keira Nakita Gandy, MS, OTR/L
• Juma Gangadeen, FNP-C
• Jamie L Ganger, LCSW
• Tricia A Gangoo, PHARMD
• Kristi Gannon
• Theodore William Gannon, L. AC.
• Anasuya Gaonkar, MD
• Roya Garakani
• Kelly Ann Garasz, RN
• Marjelin R Garay

• Low Vision Rehabilitation Optometrist in Ft Lauderdale, FL
• Providers in Ft Lauderdale, FL by specialty
• Low Vision Rehabilitation Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.