Provider Demographics
NPI:1770836546
Name:GALUZA, YELENA I (OD)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:I
Last Name:GALUZA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 GLATT CIR
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-9675
Mailing Address - Country:US
Mailing Address - Phone:503-982-3937
Mailing Address - Fax:503-982-5438
Practice Address - Street 1:590 GLATT CIR
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-9675
Practice Address - Country:US
Practice Address - Phone:503-982-3937
Practice Address - Fax:503-982-5438
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3604ATI152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program