Provider Demographics
NPI:1275608499
Name:PHILBECK, NORRIS RICK (OD)
Entity Type:Individual
Prefix:
First Name:NORRIS
Middle Name:RICK
Last Name:PHILBECK
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 1:1544 OLDENBURG DR
Mailing Address - Street 2:303
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29429-4966
Mailing Address - Country:US
Mailing Address - Phone:843-722-4416
Mailing Address - Fax:843-720-8984
Practice Address - Street 1:9270 N HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MC CLELLANVILLE
Practice Address - State:SC
Practice Address - Zip Code:29458-9422
Practice Address - Country:US
Practice Address - Phone:843-722-4416
Practice Address - Fax:843-720-8984
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC509152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD05091Medicaid
SCD05091Medicaid
SCAA6871Medicare UPIN