Provider Demographics
NPI:1326213950
Name:GALLANT-BEHAN, SUSAN M (OD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:GALLANT-BEHAN
Suffix:
Gender:F
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:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:HAMPTON FALLS
Mailing Address - State:NH
Mailing Address - Zip Code:03844-0056
Mailing Address - Country:US
Mailing Address - Phone:603-235-3009
Mailing Address - Fax:
Practice Address - Street 1:50 FOX RUN RD
Practice Address - Street 2:STE 103
Practice Address - City:NEWINGTON
Practice Address - State:NH
Practice Address - Zip Code:03801-2860
Practice Address - Country:US
Practice Address - Phone:603-828-9601
Practice Address - Fax:603-828-9601
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0716152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist