Provider Demographics
NPI:1497996474
Name:GARRY M. DEO, O.D.
Entity Type:Organization
Organization Name:GARRY M. DEO, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:734-429-9454
Mailing Address - Street 1:121 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1552
Mailing Address - Country:US
Mailing Address - Phone:734-429-9454
Mailing Address - Fax:734-429-4100
Practice Address - Street 1:121 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1552
Practice Address - Country:US
Practice Address - Phone:734-429-9454
Practice Address - Fax:734-429-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002365332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0219450001Medicare NSC