Provider Demographics
NPI:1295730687
Name:DEO, GARRY M (OD)
Entity type:Individual
Prefix:DR
First Name:GARRY
Middle Name:M
Last Name:DEO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002365152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOH16529OtherBCBS OF MICHIGAN
MI382020340OtherMEBS
MI382020340OtherVSP
MIOH16529290Medicare ID - Type Unspecified
MI0H16529Medicare PIN
MI382020340OtherMEBS
MI0219450001Medicare NSC