Provider Demographics
NPI:1508975301
Name:GALLIA, MARTHA M (OD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:M
Last Name:GALLIA
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 1:4800 N 22ND ST STE 210
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4963
Mailing Address - Country:US
Mailing Address - Phone:915-267-2020
Mailing Address - Fax:915-595-4460
Practice Address - Street 1:4171 N MESA ST STE 100
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1444
Practice Address - Country:US
Practice Address - Phone:915-267-2020
Practice Address - Fax:915-595-4460
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2262TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4187210001OtherDME
TX1316150592OtherGROUP NPI
TX80267EOtherBCBS
B27847Medicare UPIN
4187210001OtherDME
TX80267EOtherBCBS