Provider Demographics
NPI:1407803703
Name:PHILLIPS, JOSEPH H (OD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:H
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 1:3011 NW 63RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3629
Mailing Address - Country:US
Mailing Address - Phone:405-840-2800
Mailing Address - Fax:405-840-8242
Practice Address - Street 1:3011 NW 63RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3629
Practice Address - Country:US
Practice Address - Phone:405-840-2800
Practice Address - Fax:405-840-8242
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1059152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100764430AMedicaid
OKT40607Medicare UPIN
OK100764430AMedicaid