Provider Demographics
NPI:1497793947
Name:GREGORY M. GALLOUSIS MD PC
Entity Type:Organization
Organization Name:GREGORY M. GALLOUSIS MD PC
Other - Org Name:STAMFORD EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GALLOUSIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-359-2020
Mailing Address - Street 1:999 SUMMER STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5546
Mailing Address - Country:US
Mailing Address - Phone:203-359-2020
Mailing Address - Fax:203-325-4482
Practice Address - Street 1:999 SUMMER STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5546
Practice Address - Country:US
Practice Address - Phone:203-359-2020
Practice Address - Fax:203-325-4482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044280207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY83T671Medicare ID - Type Unspecified
NYG37450Medicare UPIN