Healthcare Provider Details

I. General information

NPI: 1114083938
Provider Name (Legal Business Name): GALLOWAY EYE CARE PROFESSIONALS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5688 W BROAD ST STE A
GALLOWAY OH
43119-8127
US

IV. Provider business mailing address

5670 W BROAD ST
GALLOWAY OH
43119-8127
US

V. Phone/Fax

Practice location:
  • Phone: 614-853-2020
  • Fax: 614-853-0154
Mailing address:
  • Phone: 614-853-2020
  • Fax: 614-853-0154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5635
License Number StateOH

VIII. Authorized Official

Name: DR. JENNIFER ANN MATTSON
Title or Position: PRESIDENT
Credential: O.D.
Phone: 614-853-2020