Provider Demographics
NPI:1699753624
Name:GALLERANI, RICHARD W (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:GALLERANI
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 1:656 SPRINGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:FEEDING HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:01030-2130
Mailing Address - Country:US
Mailing Address - Phone:413-789-2106
Mailing Address - Fax:413-786-6918
Practice Address - Street 1:656 SPRINGFIELD ST
Practice Address - Street 2:
Practice Address - City:FEEDING HILLS
Practice Address - State:MA
Practice Address - Zip Code:01030-2130
Practice Address - Country:US
Practice Address - Phone:413-789-2106
Practice Address - Fax:413-786-6918
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3134152W00000X, 152WC0802X
CT1082152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA12525OtherHEALTH NEW ENGLAND
MA0352683Medicaid
MA782584OtherCONNECTICARE
MAW16103OtherBLUECROSS/BLUE SHIELD
MAT59377Medicare UPIN
MA12525OtherHEALTH NEW ENGLAND