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NPI Code Detail

MEDICARE: MARJORIE JOANNE GANDY

MEDICARE: MARJORIE JOANNE GANDY
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
1156FC0800XContact Lens Technician/Technologist173863TX
2156FX1800XOptician173863TX

General Provider Information

NPI Number : 1962194787
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARJORIE JOANNE GANDY
Provider Business Mailing Address
First Line : 453 WINDMILL DR
Second Line :
City : LAVON
State : TX
Zip : 75166-1626
Country : US
Telephone Number : 469-766-0531
Fax Number : 972-908-2633
Provider Business Practice Location Address
First Line : 2662 W LUCAS RD
Second Line :
City : LUCAS
State : TX
Zip : 75002-7513
Country : US
Telephone Number : 469-675-8559
Fax Number : 972-908-2633
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2023
Last Update Date : 05/22/2023

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Directions to “ MARJORIE JOANNE GANDY ” Practice Location

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