MEDICARE: DEBRA GALLE

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	156FX1100X	Ophthalmic Technician/Technologist

General Provider Information

NPI Number	:	1861842882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA GALLE

Provider Business Mailing Address
First Line	:	N82W15340 APPLETON AVE
Second Line	:
City	:	MENOMONEE FALLS
State	:	WI
Zip	:	53051-3777
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	N82W15340 APPLETON AVE
Second Line	:
City	:	MENOMONEE FALLS
State	:	WI
Zip	:	53051-3777
Country	:	US
Telephone Number	:	262-255-5754
Fax Number	:	262-255-5429

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

Provider Enumeration Date	:	06/21/2016
Last Update Date	:	06/21/2016

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