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NPI Code Detail

MEDICARE: ROBERT L. PHILLIPS, O.D., P.A.

MEDICARE: ROBERT L. PHILLIPS, O.D., P.A.
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
1152W00000XOptometristOPC930FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053581967
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROBERT L. PHILLIPS, O.D., P.A.
Provider Business Mailing Address
First Line : 1580 BLANDING BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32210-1834
Country : US
Telephone Number : 904-387-0025
Fax Number : 904-387-0969
Provider Business Practice Location Address
First Line : 1580 BLANDING BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32210-1834
Country : US
Telephone Number : 904-387-0025
Fax Number : 904-387-0969
Authorized Official
Title or Position : OWNER
Name : ROBERT L. PHILLIPS
Credential : O.D.
Telephone Number : 904-387-0025
Provider Enumeration Date : 03/06/2008
Last Update Date : 04/09/2018

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