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General NPI Number Information
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NPI Number | 1689672396
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Entity Type | Organization
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Legal Business Name | PHILLIPS EYE CARE, P.L.L.C.
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 03/26/2009
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Provider Practice Location Address
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Address Line | 13330 EUREKA RD
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City | SOUTHGATE
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State | MI
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Zip | 48195-1310
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Country | US
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Telephone | 734-285-2990
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Fax | 734-285-2712
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Provider Business Mailing Address
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Address Line | 13330 EUREKA RD
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City | SOUTHGATE
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State | MI
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Zip | 48195-1310
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Country | US
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Telephone | 734-285-2990
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Fax | 734-285-2712
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. DANIEL PHILLIPS
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Credential | O.D.
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Telephone | 734-285-2990
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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 | 4901003890
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License Number State | MI
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