Provider Demographics
NPI:1316931769
Name:GALOS, CHRISTINA M (OD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:GALOS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511A HWY 314 SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-9600
Mailing Address - Country:US
Mailing Address - Phone:505-565-3937
Mailing Address - Fax:505-565-3900
Practice Address - Street 1:511A HWY 314 SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-9600
Practice Address - Country:US
Practice Address - Phone:505-565-3937
Practice Address - Fax:505-565-3900
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM495152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ7779Medicaid
900521038Medicare ID - Type Unspecified
NMZ7779Medicaid