Provider Demographics
NPI:1780842054
Name:GALVIN, ALONZO (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:ALONZO
Middle Name:
Last Name:GALVIN
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4514 TRAVIS ST STE 120
Mailing Address - Street 2:OAK GROVE OPTICAL
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-4112
Mailing Address - Country:US
Mailing Address - Phone:214-522-0230
Mailing Address - Fax:
Practice Address - Street 1:4514 TRAVIS ST STE 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-4112
Practice Address - Country:US
Practice Address - Phone:214-522-0230
Practice Address - Fax:214-522-0230
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1769156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
0903830001Medicare PIN