Provider Demographics
NPI:1750359634
Name:FERMAN, GREGORY BRUCE (OD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:BRUCE
Last Name:FERMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 N. SHELDON
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1524
Mailing Address - Country:US
Mailing Address - Phone:734-453-4870
Mailing Address - Fax:734-453-2849
Practice Address - Street 1:217 N. SHELDON
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1524
Practice Address - Country:US
Practice Address - Phone:734-453-4870
Practice Address - Fax:734-453-2849
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002583152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI032947001Medicaid
MIT93071Medicare UPIN
T93071Medicare UPIN
MI032947001Medicaid