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General NPI Number Information
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NPI Number | 1649362989
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Entity Type | Organization
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Legal Business Name | JEFFREY D. PHILLIPS, O.D., P.A.
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 11/10/2009
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Provider Practice Location Address
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Address Line | 1903 TYRONE BOULEVARD N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33710-4841
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Country | US
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Telephone | 727-345-4035
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Fax | 727-384-3112
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Provider Business Mailing Address
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Address Line | 1903 TYRONE BOULEVARD N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33710-4841
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Country | US
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Telephone | 727-345-4035
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Fax | 727-384-3112
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY DEAN PHILLIPS
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Credential | O.D.
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Telephone | 727-345-4035
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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 | OPC 2099
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License Number State | FL
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