Provider Demographics
NPI:1912177817
Name:DR. KENNETH D. GALLINGER
Entity Type:Organization
Organization Name:DR. KENNETH D. GALLINGER
Other - Org Name:CLEARVISION OPTICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-333-7777
Mailing Address - Street 1:12215 TOEPPERWEIN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3149
Mailing Address - Country:US
Mailing Address - Phone:210-590-3333
Mailing Address - Fax:210-590-3142
Practice Address - Street 1:12215 TOEPPERWEIN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3149
Practice Address - Country:US
Practice Address - Phone:210-590-3333
Practice Address - Fax:210-590-3142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02663T152W00000X, 152WC0802X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019183501Medicaid
TXT13376Medicare UPIN
TX00E04MMedicare PIN