| Name: | Ezra L. Galler, M.D., Ltd. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 19 Mar 1999 (26 years ago) |
| Identification Number: | 000105447 |
| ZIP code: | 02919 |
| County: | Providence County |
| Principal Address: | 100 HIGHLAND AVENUE SUITE 304, PROVIDENCE, RI, 02919, USA |
| Purpose: | TO CONDUCT AN OPHTHALMIC MEDICINE PRACTICE WHICH INCLUDES WITHOUT LIMITATION, REFRACTIVE SURGERY, LASER VISION CORRECTION, EYE EXAMINATIONS AND OTHER INCIDENTS OF AN OPHTHAMOLOGY PRACTICE. |
| Fictitious names: |
Galler Eye Care Associates (trading name, 2012-03-16 - ) |
NAICS
621111 Offices of Physicians (except Mental Health Specialists)This U.S. industry comprises establishments of health practitioners having the degree of M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathy) primarily engaged in the independent practice of general or specialized medicine (except psychiatry or psychoanalysis) or surgery. These practitioners operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or HMO medical centers. Learn more at the U.S. Census Bureau
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184630717 | 2006-08-01 | 2012-02-23 | 100 HIGHLAND AVENUE, SUITE 304, PROVIDENCE, RI, 02865, US | 100 HIGHLAND AVENUE, SUITE 304, PROVIDENCE, RI, 02906, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 401-728-1400 |
| Fax | 4012709623 |
Authorized person
| Name | EZRA L GALLER |
| Role | OWNER/PROVIDER |
| Phone | 4017281400 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | ODTG00496 |
| State | RI |
| Is Primary | No |
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | ODTA00502 |
| State | RI |
| Is Primary | No |
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| License Number | 9005 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 9025861 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| ALFRED T. MARCIANO, CPA | Agent | 18 IMPERIAL PLACE SUITE 1D, PROVIDENCE, RI, 02903, USA |
| Name | Role | Address |
|---|---|---|
| EZRA L GALLER MD | PRESIDENT | 101 BILLINGS STREET SHARON, MA 02067 USA |
| Number | Name | File Date |
|---|---|---|
| 202453603090 | Annual Report | 2024-05-01 |
| 202327783950 | Annual Report | 2023-02-07 |
| 202224636890 | Annual Report | 2022-11-10 |
| 202224637040 | Statement of Change of Registered/Resident Agent | 2022-11-10 |
| 202224637220 | Annual Report | 2022-11-10 |
| 202224636700 | Reinstatement | 2022-11-10 |
| 202104550300 | Registered Office Not Maintained | 2021-11-01 |
| 202199644430 | Revocation Certificate For Failure to File the Annual Report for the Year | 2021-07-29 |
| 202196791010 | Revocation Notice For Failure to File An Annual Report | 2021-05-19 |
| 202036564640 | Annual Report | 2020-03-18 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 5522857710 | 2020-05-01 | 0165 | PPP | 100 HIGHLAND AVE STE 304, PROVIDENCE, RI, 02906-2753 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 09 Apr 2025
Sources: Rhode Island Department of State
