Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 11755T | CA |
NPI | 1013298165 |
---|---|
Provider Name | Philip Tawil |
First Address | San Francisco, CA 94110-3716 |
Second Address | San Francisco, CA 94117-1822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2011 |
Last Update Date | 26/03/2020 |