Provider Demographics
NPI:1760677280
Name:GALE OPTICAL PC
Entity Type:Organization
Organization Name:GALE OPTICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDETTE
Authorized Official - Middle Name:JC
Authorized Official - Last Name:GALEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:903-739-9080
Mailing Address - Street 1:4025 LAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462-5212
Mailing Address - Country:US
Mailing Address - Phone:903-739-9080
Mailing Address - Fax:903-739-9084
Practice Address - Street 1:4025 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462-5212
Practice Address - Country:US
Practice Address - Phone:903-739-9080
Practice Address - Fax:903-739-9084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2709TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX IDENTIFICATION NUMBER
TX0253830002Medicare NSC