Provider Demographics
NPI:1386651545
Name:PHILPOTT, WILLIAM 'GREG' (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:'GREG'
Last Name:PHILPOTT
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 1:960 A S MOUNT OLIVE ST
Mailing Address - Street 2:P.O. BOX 188
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-0188
Mailing Address - Country:US
Mailing Address - Phone:479-524-5161
Mailing Address - Fax:479-524-8046
Practice Address - Street 1:960 A S MOUNT OLIVE ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-0188
Practice Address - Country:US
Practice Address - Phone:479-524-5161
Practice Address - Fax:479-524-8046
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2489152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR138347722Medicaid