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General NPI Number Information
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NPI Number | 1811993694
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Entity Type | Individual
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Provider Name | MICHAEL LORD PHILLIPS O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/25/2005
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Last Update Date | 02/17/2023
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Provider Practice Location Address
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Address Line | 555 ELM ST
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City | NORTH ATTLEBORO
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State | MA
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Zip | 02760-3309
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Country | US
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Telephone | 508-699-8227
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Fax | 508-699-2214
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Provider Business Mailing Address
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Address Line | 555 ELM ST
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City | NORTH ATTLEBORO
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State | MA
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Zip | 02760-3309
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Country | US
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Telephone | 508-699-8227
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Fax | 508-699-2214
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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 | 030.0133967
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License Number State | VT
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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 | ODTA00559
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3867-35
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TPOP103
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2778
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License Number State | MA
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