Provider Demographics
NPI:1114083938
Name:GALLOWAY EYE CARE PROFESSIONALS, INC.
Entity Type:Organization
Organization Name:GALLOWAY EYE CARE PROFESSIONALS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MATTSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-853-2020
Mailing Address - Street 1:5670 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-8127
Mailing Address - Country:US
Mailing Address - Phone:614-853-2020
Mailing Address - Fax:614-853-0154
Practice Address - Street 1:5670 W BROAD ST
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-8127
Practice Address - Country:US
Practice Address - Phone:614-853-2020
Practice Address - Fax:614-853-0154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5635152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty