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General NPI Number Information
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NPI Number | 1508130493
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Entity Type | Organization
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Legal Business Name | SHANE GALAN OD PC
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 84 N PARK AVE
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-4106
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Country | US
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Telephone | 516-766-2423
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Fax | 516-766-2432
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Provider Business Mailing Address
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Address Line | 84 N PARK AVE
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-4106
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Country | US
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Telephone | 516-766-2423
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Fax | 516-766-2432
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. SHANE GALAN
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Credential | OD
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Telephone | 516-766-2423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 005774
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License Number State | NY
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