MEDICARE: PHILLIPS SALOMON & PARRISH PA

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

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

General Provider Information

NPI Number	:	1811982192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILLIPS SALOMON & PARRISH PA

Provider Business Mailing Address
First Line	:	215 1ST ST N
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4537
Country	:	US
Telephone Number	:	863-299-8908
Fax Number	:	863-299-1061

Provider Business Practice Location Address
First Line	:	5528 US HIGHWAY 98 N
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33809-3104
Country	:	US
Telephone Number	:	863-853-2020
Fax Number	:	863-595-2838

Authorized Official
Title or Position	:	REGISTERED AGENT
Name	:	DR. BRAD R SALOMON
Credential	:	OD
Telephone Number	:	863-299-8908

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	02/09/2011

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