Provider Demographics
NPI:1528391760
Name:GALLINA VISION CENTER,LLC.
Entity Type:Organization
Organization Name:GALLINA VISION CENTER,LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:GALLINA
Authorized Official - Suffix:SR
Authorized Official - Credentials:NJ LICENSED OPTICIAN
Authorized Official - Phone:201-947-9797
Mailing Address - Street 1:1619 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6930
Mailing Address - Country:US
Mailing Address - Phone:201-947-9797
Mailing Address - Fax:201-947-9790
Practice Address - Street 1:1619 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6930
Practice Address - Country:US
Practice Address - Phone:201-947-9797
Practice Address - Fax:201-947-9790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00221200156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty