Provider Demographics
NPI:1649560293
Name:GALLE, JAMIE ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:ANN
Last Name:GALLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:ANN
Other - Last Name:GALLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1509 N MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-8345
Mailing Address - Country:US
Mailing Address - Phone:812-579-5695
Mailing Address - Fax:
Practice Address - Street 1:1509 N MEADOWS CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-8345
Practice Address - Country:US
Practice Address - Phone:812-579-5695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-17
Last Update Date:2011-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002440152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist