1881687168 NPI number — DR. DAVID EDWARD PHILLIPS OD

Table of content: DR. DAVID EDWARD PHILLIPS OD (NPI 1881687168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881687168 NPI number — DR. DAVID EDWARD PHILLIPS OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIPS
Provider First Name:
DAVID
Provider Middle Name:
EDWARD
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:
1881687168
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4801 S CLIFF AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64055-7015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-478-1230
Provider Business Mailing Address Fax Number:
816-478-4413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1613 S 7 HWY
Provider Second Line Business Practice Location Address:
DICSOVER VISION CENTERS
Provider Business Practice Location Address City Name:
IDEPENDENCE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-478-1230
Provider Business Practice Location Address Fax Number:
816-350-5075
Provider Enumeration Date:
08/23/2005

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:  TO2273 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00232745 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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