| 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. |
| NAICS: | 621111 - Offices of Physicians (except Mental Health Specialists) |
| Fictitious names: |
Galler Eye Care Associates (trading name, 2012-03-16 - ) |
| 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 |
Date of last update: 08 Oct 2024
Sources: Rhode Island Department of State
