Provider Demographics
NPI:1407296940
Name:GALLE, DANIEL RICHARD (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RICHARD
Last Name:GALLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57950 LEAVENWORTH ST STE 4E1
Mailing Address - Street 2:
Mailing Address - City:MCCONNELL AFB
Mailing Address - State:KS
Mailing Address - Zip Code:67221-3505
Mailing Address - Country:US
Mailing Address - Phone:316-759-6300
Mailing Address - Fax:
Practice Address - Street 1:UNIT 5267
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96368-5267
Practice Address - Country:US
Practice Address - Phone:315-630-2947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5184152W00000X
ININ18003803A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist