Provider Demographics
NPI:1447384714
Name:BELL, PHILIP TROLLINGER (OD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:TROLLINGER
Last Name:BELL
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:PO BOX 2095
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27216-2095
Mailing Address - Country:US
Mailing Address - Phone:336-228-8369
Mailing Address - Fax:336-228-0869
Practice Address - Street 1:925 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5756
Practice Address - Country:US
Practice Address - Phone:336-228-8369
Practice Address - Fax:336-228-0869
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1112152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909102Medicaid
NC56-1860763OtherFED. TAX ID. #
NC8909102Medicaid
NC246471Medicare PIN