Healthcare Provider Details

I. General information

NPI: 1760472997
Provider Name (Legal Business Name): PHILIP LEONARD DIXON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 G ST
REEDLEY CA
93654-2936
US

IV. Provider business mailing address

1056 G ST
REEDLEY CA
93654-2936
US

V. Phone/Fax

Practice location:
  • Phone: 559-638-8288
  • Fax: 559-638-2025
Mailing address:
  • Phone: 559-638-8288
  • Fax: 559-638-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: