Provider Demographics
NPI:1962579698
Name:GALPER, DIANE LYNN
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:LYNN
Last Name:GALPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27800 NOVI RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-3019
Mailing Address - Country:US
Mailing Address - Phone:248-380-3900
Mailing Address - Fax:
Practice Address - Street 1:27800 NOVI RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3019
Practice Address - Country:US
Practice Address - Phone:248-380-3900
Practice Address - Fax:248-380-3965
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002940152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU242073Medicare UPIN
MI0M89070Medicare ID - Type Unspecified