Provider Demographics
NPI:1336382381
Name:GALLATY, BEN JAY (OD)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:JAY
Last Name:GALLATY
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 1:3151 ASH GROVE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-2097
Mailing Address - Country:US
Mailing Address - Phone:904-757-9904
Mailing Address - Fax:
Practice Address - Street 1:3151 ASH GROVE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-2097
Practice Address - Country:US
Practice Address - Phone:904-757-9904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP1385152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist