Provider Demographics
NPI:1538644117
Name:GANN, DREW W (OD, MS)
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:W
Last Name:GANN
Suffix:
Gender:M
Credentials:OD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4026 VESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2554
Mailing Address - Country:US
Mailing Address - Phone:256-996-1418
Mailing Address - Fax:
Practice Address - Street 1:3099 ALLISON BONNETT MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-2261
Practice Address - Country:US
Practice Address - Phone:205-491-8755
Practice Address - Fax:205-491-8755
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-28
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-E09-TA-B21152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist