Provider Demographics
NPI:1235110149
Name:PLOTHOW, PHILLIP ANTHONY (OD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:ANTHONY
Last Name:PLOTHOW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 N 100 E
Mailing Address - Street 2:STE 250
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4597
Mailing Address - Country:US
Mailing Address - Phone:801-373-3337
Mailing Address - Fax:801-373-3339
Practice Address - Street 1:3651 N 100 E
Practice Address - Street 2:STE 250
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4597
Practice Address - Country:US
Practice Address - Phone:801-373-3337
Practice Address - Fax:801-373-3339
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1139719934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U21795Medicare UPIN
UT005750601Medicare PIN