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MARC JAY GANNON OPTOMETRIST PA
NPI 1194974782
Optometrist - Low Vision Rehabilitation in Fort Lauderdale, FL

Active since September 18, 2008
2021 E COMMERCIAL BLVD, 301, FORT LAUDERDALE, FL 33308(954) 776-5223(954) 491-0027 Get Directions Write a Review

NPPES record last updated: August 4, 2009. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Marc Jay Gannon Optometrist Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARC JAY GANNON OPTOMETRIST PA (NPI 1194974782) is a healthcare organization registered as a low vision rehabilitation in Fort Lauderdale, Florida and active in the NPI registry since September 2008. The organization lists Marc Jay Gannon, Director, as its authorized official.

NPPES Registry Identity

NPI1194974782
Entity TypeOrganization
Primary Taxonomy152WL0500X
Legal Business NameMARC JAY GANNON OPTOMETRIST PA
Location Address2021 E COMMERCIAL BLVD, 301Fort Lauderdale, FL 33308-3763
Mailing Address2021 E Commercial Blvd, 301Fort Lauderdale, FL 33308-3763 · (954) 776-5223 · Fax (954) 491-0027
Phone(954) 776-5223
Fax(954) 491-0027
Organization SubpartNo
Authorized OfficialMarc Jay GannonDirector · (954) 776-5223
Enumeration DateSeptember 18, 2008
Last NPPES UpdateAugust 4, 2009
✔ NPI 1194974782 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometrist · Low Vision RehabilitationEye and Vision Services Providers
Taxonomy Code152WL0500X
License✔ Licensed in FL · OPC1271
Definition
Optometrists who specialize in low-vision care having training to assess visual function, prescribe low-vision devices, develop treatment plans, and recommend other vision rehabilitation services.
2021 E COMMERCIAL BLVD, Fort Lauderdale, FL 33308
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Other Identifiers 2

Medicare UPINT84099
Medicaid078390100FL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Marc Jay Gannon Optometrist Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Marc Jay Gannon Optometrist PA, which bills Medicare for the services this clinician delivers.

Clinician (1)

Marc Gannon, O.D.
Optometry
NPI 1841286424
2021 E COMMERCIAL BLVD SUITE #301
Ft Lauderdale, FL 33308
(954) 776-5223
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Marc Jay Gannon Optometrist PA's NPI number?

The NPI number for Marc Jay Gannon Optometrist PA is 1194974782. It was assigned to this organization in the NPPES registry on September 18, 2008.

Where is Marc Jay Gannon Optometrist PA located?

Marc Jay Gannon Optometrist PA is located at 2021 E Commercial Blvd 301, Fort Lauderdale, FL 33308. The listed phone number is (954) 776-5223.

What is Marc Jay Gannon Optometrist PA's specialty?

The primary specialty registered for this NPI is Optometrist, specializing in Low Vision Rehabilitation, with taxonomy code 152WL0500X.

Is Marc Jay Gannon Optometrist PA enrolled in Medicare?

Yes. Marc Jay Gannon Optometrist PA is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Marc Jay Gannon Optometrist PA?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Optometry) reassigns their Medicare billing to Marc Jay Gannon Optometrist PA. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Marc Jay Gannon Optometrist PA was last updated on August 4, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.