Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | S-E34 | AL |
NPI | 1003438904 |
---|---|
Provider Name | Taylor Phillips |
First Address | Gilbertown, AL 36908-0218 |
Second Address | Demopolis, AL 36732-4127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2020 |
Last Update Date | 13/05/2020 |