Provider Demographics
NPI:1902832231
Name:GALEN, CLAUDETTE CALLAWAY (OD)
Entity Type:Individual
Prefix:
First Name:CLAUDETTE
Middle Name:CALLAWAY
Last Name:GALEN
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 1:2801 LEMMON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2356
Mailing Address - Country:US
Mailing Address - Phone:903-436-3218
Mailing Address - Fax:
Practice Address - Street 1:2801 LEMMON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2356
Practice Address - Country:US
Practice Address - Phone:903-436-3218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2709TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0253830002Medicare NSC
TX8F7716Medicare PIN