Healthcare Provider Details

I. General information

NPI: 1528053808
Provider Name (Legal Business Name): PHILLIPS SALOMON & PARRISH PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 US HIGHWAY 27 N
SEBRING FL
33870-1691
US

IV. Provider business mailing address

215 1ST ST N SUITE 100
WINTER HAVEN FL
33881-4537
US

V. Phone/Fax

Practice location:
  • Phone: 863-402-1300
  • Fax: 863-382-1410
Mailing address:
  • Phone: 863-299-8908
  • Fax: 863-299-1061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRAD R SALOMON
Title or Position: REGISTERED AGENT
Credential: OD
Phone: 863-299-8908