MEDICARE: MARTHA M GALLIA OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2262TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4187210001	OTHER		DME
2	1316150592	OTHER	TX	GROUP NPI
3	80267E	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1508975301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA M GALLIA OD

Provider Business Mailing Address
First Line	:	4800 N 22ND ST STE 210
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4963
Country	:	US
Telephone Number	:	915-267-2020
Fax Number	:	915-595-4460

Provider Business Practice Location Address
First Line	:	4171 N MESA ST STE 100
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-1444
Country	:	US
Telephone Number	:	915-267-2020
Fax Number	:	915-595-4460

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	01/11/2023

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