Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPC004375 | FL |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPC004375 | FL |
NPI | 1164674974 |
---|---|
Provider Name | Dr. Renee Gayle Phipps |
First Address | Daytona Beach, FL 32114-5331 |
Second Address | Daytona Beach, FL 32114-5331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2008 |
Last Update Date | 13/10/2008 |