NPIMap

Organization Active NPI

Optical Galleria PLLC

  • Optician
  • Fort Myers, FL
National Provider Identifier
1518575513
Registry record updated Jul 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
Legal business name
OPTICAL GALLERIA PLLC
Practice address
4135 Dr Martin Luther King Blvd # G16
Fort Myers, FL 33916-4809
Phone
(239) 313-5259
Fax
(239) 672-4368
NPI assigned
Jul 16, 2020
Last updated
Jul 16, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Christian GonzalezNPI 1306464292
Title
Licensed Optician
Phone
(239) 270-8170

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optician 156FX1800X NU Primary

Addresses

Primary practice location

4135 Dr Martin Luther King Blvd # G16
Fort Myers, FL 33916-4809

Mailing address

4135 Dr Martin Luther King Blvd # G16
Fort Myers, FL 33916-4809
Phone (239) 313-5259

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL opticalgalleria16@gmail.com Direct

National Provider Directory

National Provider Directory

Locations

4135 Dr Martin Luther King Blvd
#G16
Fort Myers, FL 33916
Phone (239) 313-5259

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594857600000",
    "number": "1518575513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4135 DR MARTIN LUTHER KING BLVD # G16",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339164809",
            "telephone_number": "239-313-5259",
            "fax_number": "239-672-4368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4135 DR MARTIN LUTHER KING BLVD # G16",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339164809",
            "telephone_number": "239-313-5259",
            "fax_number": "239-672-4368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTICAL GALLERIA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-16",
        "last_updated": "2020-07-16",
        "certification_date": "2020-07-16",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_title_or_position": "LICENSED OPTICIAN",
        "authorized_official_telephone_number": "239-270-8170"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "opticalgalleria16@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "4135 Dr Martin Luther King Blvd # G16",
            "city": "Fort Myers",
            "state": "FL",
            "country_code": "US",
            "postal_code": "339164809",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.