MEDICARE: GANLY VISION CARE, PC

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	PA OEG 00372	PA

General Provider Information

NPI Number	:	1922235456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GANLY VISION CARE, PC

Provider Business Mailing Address
First Line	:	109 HILLSIDE LN
Second Line	:
City	:	KENNETT SQUARE
State	:	PA
Zip	:	19348-2267
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 BAYARD RD
Second Line	:	SUITE 200
City	:	KENNETT SQUARE
State	:	PA
Zip	:	19348-1862
Country	:	US
Telephone Number	:	610-444-6703
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KEN E GANLY
Credential	:	OD
Telephone Number	:	610-444-6703

Provider Enumeration Date	:	06/10/2009
Last Update Date	:	06/10/2009

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Directions to “GANLY VISION CARE, PC ” Practice Location

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