Provider Demographics
NPI:1558339382
Name:GALLAGHER, JOSEPH W (OD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:W
Last Name:GALLAGHER
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 1:53 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-2022
Mailing Address - Country:US
Mailing Address - Phone:603-643-2140
Mailing Address - Fax:
Practice Address - Street 1:6 SOUTH ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-2148
Practice Address - Country:US
Practice Address - Phone:603-643-2140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0810152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME1627Medicare ID - Type Unspecified
MEV07045Medicare UPIN