MEDICARE: PAUL D GAMMAGE OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901003318	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	900G010150	OTHER	MI	BLUE CROSS BLUE SHIELD
2	MI3318	OTHER	MI	EYEMED
3	P31367F	OTHER	MI	BLUE CARE NETWORK
4	382911868	OTHER	MI	PRIORITY HEALTH
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104918820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL D GAMMAGE OD

Provider Business Mailing Address
First Line	:	3232 CENTRAL BLVD
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-1439
Country	:	US
Telephone Number	:	616-669-2530
Fax Number	:	616-669-3646

Provider Business Practice Location Address
First Line	:	3232 CENTRAL BLVD
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-1439
Country	:	US
Telephone Number	:	616-669-2530
Fax Number	:	616-669-3646

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	06/24/2024

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