Provider Demographics
NPI:1063734648
Name:GALLO EYE SURGICAL, ASSOC, INC
Entity type:Organization
Organization Name:GALLO EYE SURGICAL, ASSOC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARYBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:724-430-2020
Mailing Address - Street 1:649 CHERRY TREE LN
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-8947
Mailing Address - Country:US
Mailing Address - Phone:724-430-2020
Mailing Address - Fax:724-430-2022
Practice Address - Street 1:649 CHERRY TREE LN
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8947
Practice Address - Country:US
Practice Address - Phone:724-430-2020
Practice Address - Fax:724-430-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021446E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty