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General NPI Number Information
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NPI Number | 1699768689
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Entity Type | Individual
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Provider Name | ROBERT LOWELL PHILLIPS O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/25/2005
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Last Update Date | 04/06/2018
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Provider Practice Location Address
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Address Line | 534 S 5TH ST
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City | MACCLENNY
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State | FL
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Zip | 32063-2602
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Country | US
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Telephone | 904-259-6797
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Fax | 904-259-5230
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Provider Business Mailing Address
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Address Line | PO BOX 886
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City | MACCLENNY
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State | FL
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Zip | 32063-0886
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Country | US
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Telephone | 904-259-6797
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Fax | 904-387-0969
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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 | OB233
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC930
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License Number State | FL
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