Provider Demographics
NPI:1790720118
Name:GANLY VISION CARE, PC
Entity Type:Organization
Organization Name:GANLY VISION CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GANLY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:484-770-8132
Mailing Address - Street 1:109 HILLSIDE LN
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2267
Mailing Address - Country:US
Mailing Address - Phone:484-770-8132
Mailing Address - Fax:484-770-8136
Practice Address - Street 1:402 BAYARD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-1862
Practice Address - Country:US
Practice Address - Phone:484-770-8132
Practice Address - Fax:484-770-8136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA021433Medicare PIN