MEDICARE: DR. JULIA H GANNON 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	S708TA316	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	51502838	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1760478226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIA H GANNON OD

Provider Business Mailing Address
First Line	:	1201 11TH AVE S
Second Line	:	SUITE 501
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-3423
Country	:	US
Telephone Number	:	205-930-0930
Fax Number	:	205-930-9050

Provider Business Practice Location Address
First Line	:	1201 11TH AVE S
Second Line	:	SUITE 501
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-3423
Country	:	US
Telephone Number	:	205-930-0930
Fax Number	:	205-930-9050

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	10/18/2017

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