Healthcare Provider Details

I. General information

NPI: 1497996474
Provider Name (Legal Business Name): GARRY M. DEO, O.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2009
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E MICHIGAN AVE
SALINE MI
48176-1552
US

IV. Provider business mailing address

121 E MICHIGAN AVE
SALINE MI
48176-1552
US

V. Phone/Fax

Practice location:
  • Phone: 734-429-9454
  • Fax: 734-429-4100
Mailing address:
  • Phone: 734-429-9454
  • Fax: 734-429-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number4901002365
License Number StateMI

VIII. Authorized Official

Name: DR. GARRY M DEO
Title or Position: OWNER
Credential: OD
Phone: 734-429-9454