Healthcare Provider Details

I. General information

NPI: 1053306431
Provider Name (Legal Business Name): THOMAS SAMUEL PHILLIPS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date: 03/25/2006
Reactivation Date: 03/31/2006

III. Provider practice location address

179 YORK RD
WARMINSTER PA
18974-4514
US

IV. Provider business mailing address

448 COBBLESTONE WAY
DOYLESTOWN PA
18901-5744
US

V. Phone/Fax

Practice location:
  • Phone: 215-674-2020
  • Fax: 215-674-4323
Mailing address:
  • Phone: 215-348-3288
  • Fax: 215-674-4323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000901
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: