Provider Demographics
NPI:1255494662
Name:RICE, PHILIP (OD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:RICE
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 1:11103 WEST AVE
Mailing Address - Street 2:STE 6
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1370
Mailing Address - Country:US
Mailing Address - Phone:210-524-6803
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:5953 W PARK AVE
Practice Address - Street 2:1031
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-1450
Practice Address - Country:US
Practice Address - Phone:985-868-0699
Practice Address - Fax:985-868-0535
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA689126T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAT19476Medicare UPIN
LA47874CJ16Medicare ID - Type UnspecifiedMEDICARE