Provider Demographics
NPI:1477786549
Name:GALOS, PATRICIA A (OD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:GALOS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:103 W GIBSON ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-4977
Mailing Address - Country:US
Mailing Address - Phone:409-381-8100
Mailing Address - Fax:409-381-9101
Practice Address - Street 1:2051 S WHEELER ST STE C
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-5600
Practice Address - Country:US
Practice Address - Phone:409-384-2020
Practice Address - Fax:409-384-5102
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX7297TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457883ZR4GMedicare PIN