Physician Compare National (NPI:1396793204)

HEALTHCARE PROVIDER: AMY RENEE GALLEGOS O.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1396793204
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5698711323
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050705000491
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GALLEGOS
	Individual professional last name
Provider First Name	AMY
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.
Provider Credential Text	OD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	INDIANA UNIVERSITY - SCHOOL OF OPTOMETRY
	Individual professional's medical school
Graduation Year	2003
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	123 A W HAMPDEN AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	EYE LOGIC
	Group Practice or individual's line 2 address
City	ENGLEWOOD
	Group Practice or individual's city
State	CO
	Group Practice or individual's state
Zip Code	801102430
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y