Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | T03068 | MO |
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | T03068 | MO |
NPI | 1326016601 |
---|---|
Provider Name | Cathy L Phillips |
First Address | Eureka, MO 63025-1205 |
Second Address | Pacific, MO 63069-1331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 18/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MA5227028 | (02) | MO |