Healthcare Provider Details

I. General information

NPI: 1508130493
Provider Name (Legal Business Name): SHANE GALAN OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 N PARK AVE
ROCKVILLE CENTRE NY
11570-4106
US

IV. Provider business mailing address

84 N PARK AVE
ROCKVILLE CENTRE NY
11570-4106
US

V. Phone/Fax

Practice location:
  • Phone: 516-766-2423
  • Fax: 516-766-2432
Mailing address:
  • Phone: 516-766-2423
  • Fax: 516-766-2432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number005774
License Number StateNY

VIII. Authorized Official

Name: DR. SHANE GALAN
Title or Position: OWNER/OPERATOR
Credential: OD
Phone: 516-766-2423