Provider Demographics
NPI:1598831612
Name:GALAN, SHANE M (OD)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:M
Last Name:GALAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:84 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4106
Mailing Address - Country:US
Mailing Address - Phone:516-766-2423
Mailing Address - Fax:516-766-2432
Practice Address - Street 1:84 N. PARK AVE.
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4106
Practice Address - Country:US
Practice Address - Phone:516-766-2423
Practice Address - Fax:516-766-2432
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005774152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4023970001Medicare NSC