Individual
BRIAN CULLIGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
516 E. NIZHONI BLVD, BOX 1337, GALLUP, NM 87301-1337
(505) 722-1000
(505) 722-1747
Mailing address
516 E. NIZHONI BLVD, BOX 1337, GALLUP, NM 87301-1337
(505) 722-1000
(505) 722-1747
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1930
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000S0428
—
NM
05
—
415241
—
AZ
Enumeration date
07/05/2006
Last updated
04/11/2008
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