Provider Demographics
NPI:1598276180
Name:4 SIGHT VISION CENTER, PC
Entity Type:Organization
Organization Name:4 SIGHT VISION CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GALOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:409-384-2020
Mailing Address - Street 1:715 LIVE OAK RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-3319
Mailing Address - Country:US
Mailing Address - Phone:409-594-9097
Mailing Address - Fax:
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
Practice Address - Country:US
Practice Address - Phone:409-384-2020
Practice Address - Fax:409-384-5102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7297TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty