Individual
EZRA LOUIS L. GALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 HIGHLAND AVE, SUITE 304, PROVIDENCE, RI 02906
(401) 728-1400
(401) 270-9623
Mailing address
100 HIGHLAND AVE., SUITE 304, PROVIDENCE, RI 02906
(401) 728-1400
(401) 270-9623
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
00496
RI
207W00000X
Ophthalmology Physician
79430
MA
207W00000X
Ophthalmology Physician
Primary
9005
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207
—
RI
Enumeration date
05/01/2006
Last updated
03/19/2012
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