Provider Demographics
NPI:1720294663
Name:GALA, NITA (OD)
Entity Type:Individual
Prefix:DR
First Name:NITA
Middle Name:
Last Name:GALA
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 1:17722 CRICKET HILL DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-3458
Mailing Address - Country:US
Mailing Address - Phone:301-528-8246
Mailing Address - Fax:
Practice Address - Street 1:5604 BUCKEYSTOWN PIKE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8312
Practice Address - Country:US
Practice Address - Phone:301-682-7140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1308152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist