1528162823 NPI number — DR. PHILLIP POLSTER OD

Table of content: DR. PHILLIP POLSTER OD (NPI 1528162823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528162823 NPI number — DR. PHILLIP POLSTER OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLSTER
Provider First Name:
PHILLIP
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528162823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1250 W HENDERSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTERVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-783-8277
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1250 W HENDERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-783-8277
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  CAOPT5319TPA , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: SD0053190 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03275 . This is a "SPECTERA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 48737 . This is a "SAFEGUARD PPO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 086510 . This is a "HEALTH NET" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 47023 . This is a "SAFEGUARD HMO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 6199 . This is a "MEDICAL EYE SERVICES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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