Provider Demographics
NPI:1063675247
Name:GALVAN, CANDICE ANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:ANNE
Last Name:GALVAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614N CABARTON LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4511
Mailing Address - Country:US
Mailing Address - Phone:562-756-4409
Mailing Address - Fax:208-377-5853
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?:No
Enumeration Date:2008-07-08
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13506152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist