Wallace L Phillips

NPI 1003040452 - Optometrist - 152W00000X

NPI Details
NPI 1003040452
Enumeration Date 05/13/2009
Last Updated 05/13/2009
Entity Type Healthcare Provider
Active Over 7 years ago
Authorized Information
Name WALLACE L WALLACE
Position OWNER
Phone (432) 586-3435
Fax (432) 586-6737
Practice Location
103 S EAST AVE
KERMIT TX, 79745-3606, US
Phone (432) 586-3435
Fax (432) 586-6737
Business Location
103 S EAST AVE
KERMIT TX, 79745-3606, US
Phone (432) 586-3435
Fax (432) 586-6737
Toxanomy
Taxonomy Code 152W00000X
License State Texas
License Number 2869TG
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According to our database, Wallace L Phillips NPI is 1003040452, taxonomy code is 152W00000X and license number is 2869TG, license state is located at Texas. Wallace L Phillips physically located at 103 S East Ave, Kermit TX, 79745-3606. NPI Number 1033115704 has the healthcare provider type.

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1003040452 NPI number is provided on an as is basis without warranty of any kind. 1003040452 is maintained by the National Plan & Provider Enumeration System. The contents of Wallace L Phillips are for informational purposes only.