Healthcare Provider Details

I. General information

NPI: 1366522427
Provider Name (Legal Business Name): ANDREW F. PHILLIPS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W HUNTINGTON DR SUITE 605
ARCADIA CA
91007-3462
US

IV. Provider business mailing address

301 W. HUNTINGTON DRIVE SUITE 605
ARCADIA CA
91007-3462
US

V. Phone/Fax

Practice location:
  • Phone: 626-446-1600
  • Fax: 626-446-9986
Mailing address:
  • Phone: 626-446-1600
  • Fax: 626-446-9986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberG78557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: