Provider Demographics
NPI:1821078684
Name:NGALA, KOYOH JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:KOYOH
Middle Name:JOHN
Last Name:NGALA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6191 CENTRAL CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-3818
Mailing Address - Country:US
Mailing Address - Phone:409-744-4940
Mailing Address - Fax:409-744-6036
Practice Address - Street 1:6191 CENTRAL CITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551-3818
Practice Address - Country:US
Practice Address - Phone:409-744-4940
Practice Address - Fax:409-744-6036
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5306TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00531PMedicare ID - Type Unspecified
TX00E61VMedicare ID - Type Unspecified
TXU63748Medicare UPIN