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General NPI Number Information
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NPI Number | 1174304547
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Entity Type | Individual
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Provider Name | PHILLIP MARK BARLOW OD
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Gender | Male
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Dates
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Enumeration Date | 10/11/2023
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 4425 E MCKELLIPS RD STE 112
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City | MESA
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State | AZ
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Zip | 85215-2550
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Country | US
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Telephone | 480-333-6904
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Fax |
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Provider Business Mailing Address
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Address Line | 8833 E FOUNTAIN ST
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City | MESA
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State | AZ
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Zip | 85207-5121
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Country | US
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Telephone | 775-342-4687
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT002751
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License Number State | AZ
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