Provider Demographics
NPI:1174605257
Name:GALA, PURVI (OD)
Entity type:Individual
Prefix:
First Name:PURVI
Middle Name:
Last Name:GALA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2425
Mailing Address - Country:US
Mailing Address - Phone:956-583-0202
Mailing Address - Fax:956-583-0200
Practice Address - Street 1:8607 MCPHERSON RD STE 102
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6383
Practice Address - Country:US
Practice Address - Phone:956-753-0202
Practice Address - Fax:956-583-0200
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001412152W00000X
TX9824T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX414974201Medicaid