Provider Demographics
NPI:1770776205
Name:SCHWANER, GALEN L (OD)
Entity type:Individual
Prefix:
First Name:GALEN
Middle Name:L
Last Name:SCHWANER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 GREELEY MALL
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-8517
Mailing Address - Country:US
Mailing Address - Phone:970-356-1548
Mailing Address - Fax:970-304-6342
Practice Address - Street 1:2800 GREELEY MALL
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-8517
Practice Address - Country:US
Practice Address - Phone:970-356-1548
Practice Address - Fax:970-304-6342
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2198152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist