Provider Demographics
NPI:1043426927
Name:GALVAN, MARK ANTHONY (OD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTHONY
Last Name:GALVAN
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 1:6711 COMSTOCK AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-4106
Mailing Address - Country:US
Mailing Address - Phone:562-698-0027
Mailing Address - Fax:562-693-4418
Practice Address - Street 1:6711 COMSTOCK AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-4106
Practice Address - Country:US
Practice Address - Phone:562-698-0027
Practice Address - Fax:562-693-4418
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA07192T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU18921Medicare UPIN
CAWOP7192AMedicare PIN