Provider Demographics
NPI:1447429535
Name:GALLAGHER OPTICAL INC
Entity Type:Organization
Organization Name:GALLAGHER OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-744-7450
Mailing Address - Street 1:357 CYPRESS DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-3060
Mailing Address - Country:US
Mailing Address - Phone:561-744-7450
Mailing Address - Fax:561-744-9742
Practice Address - Street 1:357 CYPRESS DR
Practice Address - Street 2:SUITE 4
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-3060
Practice Address - Country:US
Practice Address - Phone:561-744-7450
Practice Address - Fax:561-744-9742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO2035332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD6680Medicare PIN
FL0690910001Medicare NSC