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General NPI Number Information
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NPI Number | 1376827675
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Entity Type | Organization
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Legal Business Name | PATRICIA GALOS, OD PC
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 802 W GIBSON ST
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City | JASPER
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State | TX
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Zip | 75951-4914
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Country | US
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Telephone | 505-280-0258
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Fax |
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Provider Business Mailing Address
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Address Line | 802 W GIBSON ST
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City | JASPER
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State | TX
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Zip | 75951-4914
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | PATRICIA GALOS
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Credential | OD
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Telephone | 505-280-0258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 7297TG
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License Number State | TX
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