MEDICARE: GALLERY VISION INC

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

General Provider Information

NPI Number	:	1518480383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GALLERY VISION INC

Provider Business Mailing Address
First Line	:	523 FULTON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5349
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	523 FULTON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5349
Country	:	US
Telephone Number	:	718-625-8590
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANNY PINHASOV
Credential	:
Telephone Number	:	718-625-8590

Provider Enumeration Date	:	07/24/2017
Last Update Date	:	07/24/2017

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