Provider Demographics
NPI:1427104595
Name:GEDDA, JOHN M (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:GEDDA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2915 WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1419
Mailing Address - Country:US
Mailing Address - Phone:248-375-0022
Mailing Address - Fax:248-375-0248
Practice Address - Street 1:2915 WALTON BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1419
Practice Address - Country:US
Practice Address - Phone:248-375-0022
Practice Address - Fax:248-375-0248
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4901002672152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4170671Medicaid
MI4170671Medicaid