Provider Demographics
NPI:1053306431
Name:PHILLIPS, THOMAS SAMUEL (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SAMUEL
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 COBBLESTONE WAY
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-5744
Mailing Address - Country:US
Mailing Address - Phone:215-348-3288
Mailing Address - Fax:215-674-4323
Practice Address - Street 1:179 YORK RD
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-4514
Practice Address - Country:US
Practice Address - Phone:215-674-2020
Practice Address - Fax:215-674-4323
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2011-09-16
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
PAOEG000901152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA725020Medicare PIN
PA0417020001Medicare NSC
PA725020VP1Medicare PIN