MEDICARE: DR. KOYOH JOHN NGALA O.D.

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	5306TG	TX

General Provider Information

NPI Number	:	1821078684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KOYOH JOHN NGALA O.D.

Provider Business Mailing Address
First Line	:	6191 CENTRAL CITY BLVD
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77551-3818
Country	:	US
Telephone Number	:	409-744-4940
Fax Number	:	409-744-6036

Provider Business Practice Location Address
First Line	:	6191 CENTRAL CITY BLVD
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77551-3818
Country	:	US
Telephone Number	:	409-744-4940
Fax Number	:	409-744-6036

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	06/17/2024

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