Healthcare Provider Details

I. General information

NPI: 1891331534
Provider Name (Legal Business Name): STAMFORD EYE ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 SUMMER ST STE 105
STAMFORD CT
06905-5546
US

IV. Provider business mailing address

999 SUMMER ST STE 105
STAMFORD CT
06905-5546
US

V. Phone/Fax

Practice location:
  • Phone: 203-359-2020
  • Fax: 203-325-4482
Mailing address:
  • Phone: 203-359-2020
  • Fax: 203-325-4482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY M. GALLOUSIS
Title or Position: OWNER/MD
Credential: MD
Phone: 203-359-2020