MEDICARE: JOSEPH H PHILLIPS OD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1059	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	445625675-002	OTHER	OK	BCBS OF OKLAHOMA

General Provider Information

NPI Number	:	1023235371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH H PHILLIPS OD INC

Provider Business Mailing Address
First Line	:	5565 NW EXPRESSWAY ST
Second Line	:
City	:	WARR ACRES
State	:	OK
Zip	:	73132-5230
Country	:	US
Telephone Number	:	405-721-0877
Fax Number	:	405-721-2294

Provider Business Practice Location Address
First Line	:	5565 NW EXPRESSWAY ST
Second Line	:
City	:	WARR ACRES
State	:	OK
Zip	:	73132-5230
Country	:	US
Telephone Number	:	405-721-0877
Fax Number	:	405-721-2294

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH H PHILLIPS
Credential	:	OD
Telephone Number	:	405-721-0877

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	09/24/2008

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Directions to “JOSEPH H PHILLIPS OD INC ” Practice Location

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