Provider Demographics
NPI:1821010323
Name:GALLOWAY, SLADE STEVEN (OD)
Entity type:Individual
Prefix:DR
First Name:SLADE
Middle Name:STEVEN
Last Name:GALLOWAY
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 1:1180 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1345
Mailing Address - Country:US
Mailing Address - Phone:740-454-6283
Mailing Address - Fax:740-454-6289
Practice Address - Street 1:1180 MILITARY RD
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1345
Practice Address - Country:US
Practice Address - Phone:740-454-6283
Practice Address - Fax:740-454-6289
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5389152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000313372OtherBC/BS
OH2422748Medicaid
OHP00100801OtherRAILROAD MEDICARE
OH000000313372OtherBC/BS
OH4115652Medicare PIN
OHP00100801OtherRAILROAD MEDICARE