Provider Demographics
NPI:1053205138
Name:GEORGALLIS, MAYA NICOLE (OD)
Entity type:Individual
Prefix:DR
First Name:MAYA
Middle Name:NICOLE
Last Name:GEORGALLIS
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:975 LANDMARK WAY UNIT 7
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4190
Mailing Address - Country:US
Mailing Address - Phone:925-998-5751
Mailing Address - Fax:925-998-5751
Practice Address - Street 1:3609 S TIMBERLINE RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3430
Practice Address - Country:US
Practice Address - Phone:970-377-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0004114152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist