Provider Demographics
NPI:1265414114
Name:GALEUCIA, STEWART EDWARD (OD)
Entity type:Individual
Prefix:DR
First Name:STEWART
Middle Name:EDWARD
Last Name:GALEUCIA
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 1:85 RIVER RD
Mailing Address - Street 2:APT K2
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1345
Mailing Address - Country:US
Mailing Address - Phone:860-215-0256
Mailing Address - Fax:
Practice Address - Street 1:150 GOLD STAR HWY
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-3442
Practice Address - Country:US
Practice Address - Phone:860-448-2022
Practice Address - Fax:508-484-2008
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002803152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0348023Medicaid
MA0348023Medicaid
CTD300066926Medicare PIN
T59376Medicare UPIN