Healthcare Provider Details

I. General information

NPI: 1720993702
Provider Name (Legal Business Name): GABRIELLE MARIE CANANT OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 482 BOX 1600
FPO AP
96362-0017
US

IV. Provider business mailing address

3611 BRIDGEPOINTE
OWENSBORO KY
42303-1791
US

V. Phone/Fax

Practice location:
  • Phone: 819-897-1935
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2471DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: