Physician Compare National (NPI:1366456972)

HEALTHCARE PROVIDER: PHILLIP PATRICK FOWLER O.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1366456972
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8224013719
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040621000019
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FOWLER
	Individual professional last name
Provider First Name	PHILLIP
	Individual professional first name
Provider Middle Name	P
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	OD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	SOUTHERN COLLEGE OF OPTOMETRY
	Individual professional's medical school
Graduation Year	2003
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	ELITE EYE CARE AND OPTICAL LLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	7416053368
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	4
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1000 WINDOVER
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE C
	Group Practice or individual's line 2 address
City	JONESBORO
	Group Practice or individual's city
State	AR
	Group Practice or individual's state
Zip Code	724016067
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8709726040
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y