Provider Demographics
NPI:1356323836
Name:GALANTI, JEROME A (OD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:A
Last Name:GALANTI
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 1:130 W PLANK RD
Mailing Address - Street 2:SEARS LOGAN VALLEY MALL
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-3012
Mailing Address - Country:US
Mailing Address - Phone:814-944-8685
Mailing Address - Fax:814-942-4313
Practice Address - Street 1:130 W PLANK RD
Practice Address - Street 2:SEARS LOGAN VALLEY MALL
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-3012
Practice Address - Country:US
Practice Address - Phone:814-944-8685
Practice Address - Fax:814-942-4313
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG 001565152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGA565248Medicare ID - Type UnspecifiedHGS ADMINISTRATORS
PAUO1450Medicare UPIN