MEDICARE: JEFFREY D. 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
1	152W00000X	Optometrist	OPC 2099	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1649362989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY D. PHILLIPS, O.D., P.A.

Provider Business Mailing Address
First Line	:	1903 TYRONE BOULEVARD N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33710-4841
Country	:	US
Telephone Number	:	727-345-4035
Fax Number	:	727-384-3112

Provider Business Practice Location Address
First Line	:	1903 TYRONE BOULEVARD N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33710-4841
Country	:	US
Telephone Number	:	727-345-4035
Fax Number	:	727-384-3112

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFFREY DEAN PHILLIPS
Credential	:	O.D.
Telephone Number	:	727-345-4035

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	11/10/2009

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