Provider Demographics
NPI:1962572420
Name:GALLINGER, MONTE A (OD)
Entity type:Individual
Prefix:DR
First Name:MONTE
Middle Name:A
Last Name:GALLINGER
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 1:17307 SE 272ND ST STE 118
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-5306
Mailing Address - Country:US
Mailing Address - Phone:253-630-3400
Mailing Address - Fax:253-638-0122
Practice Address - Street 1:17307 SE 272ND ST STE 118
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-5306
Practice Address - Country:US
Practice Address - Phone:253-630-3400
Practice Address - Fax:253-638-0122
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1423152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0084961OtherDLI
WAG000106180Medicare PIN
T01928Medicare UPIN