Provider Demographics
NPI:1407861834
Name:HOOKER, PHILLIP A (OD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:A
Last Name:HOOKER
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 1:726 GOODMAN RD E
Mailing Address - Street 2:# B
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9530
Mailing Address - Country:US
Mailing Address - Phone:662-349-1959
Mailing Address - Fax:662-349-0424
Practice Address - Street 1:726 GOODMAN RD E
Practice Address - Street 2:# B
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9530
Practice Address - Country:US
Practice Address - Phone:662-349-1959
Practice Address - Fax:662-349-0424
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS744152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04679751Medicaid
MSV07496Medicare UPIN
MS410000351Medicare PIN