Provider Demographics
NPI:1609841469
Name:GALLINGER, JAY VALENTINE (OD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:VALENTINE
Last Name:GALLINGER
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 1:66 NW BOISTFORT ST
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-2003
Mailing Address - Country:US
Mailing Address - Phone:360-748-6191
Mailing Address - Fax:360-748-7208
Practice Address - Street 1:66 NW BOISTFORT ST
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2003
Practice Address - Country:US
Practice Address - Phone:360-748-6191
Practice Address - Fax:360-748-7208
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001920152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2011658Medicaid
WAU11513Medicare UPIN
WA0671680001Medicare NSC