Provider Demographics
NPI:1285661454
Name:GALLOWAY REGIONAL EYE CENTER PA
Entity Type:Organization
Organization Name:GALLOWAY REGIONAL EYE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-943-2010
Mailing Address - Street 1:PO BOX 49847
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-0015
Mailing Address - Country:US
Mailing Address - Phone:864-943-2010
Mailing Address - Fax:964-323-0345
Practice Address - Street 1:202 OVERLAND DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4069
Practice Address - Country:US
Practice Address - Phone:864-943-2010
Practice Address - Fax:864-323-0345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7563207W00000X
SC29742207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4102Medicaid
SCDF8980OtherRAILROAD MEDICARE GROUP
SC7563Medicare PIN