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General NPI Number Information
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NPI Number | 1467657916
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Entity Type | Organization
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Legal Business Name | PHILLIPS VISION LLC
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 4109 MOORES LN
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City | TEXARKANA
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State | TX
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Zip | 75503-2159
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Country | US
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Telephone | 903-329-5051
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Fax | 903-329-5053
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Provider Business Mailing Address
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Address Line | 4109 MOORES LN
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City | TEXARKANA
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State | TX
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Zip | 75503-2159
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Country | US
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Telephone | 903-329-5051
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Fax | 903-329-5053
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Authorized Official
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Title or Position | BILLING/CREDENTIALING MANAGER
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Name | SHELIA K BAILEY
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Credential |
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Telephone | 903-329-5051
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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 | 5480T
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License Number State | TX
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