MEDICARE: DR. JENNIFER L. GALLO O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC3656	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912905290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER L. GALLO O.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 101427
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	32910
Country	:	US
Telephone Number	:	239-542-2020
Fax Number	:	239-541-1492

Provider Business Practice Location Address
First Line	:	900 PINE ISLAND ROAD
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991
Country	:	US
Telephone Number	:	239-542-2020
Fax Number	:	239-541-1492

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	09/01/2020

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