Provider Demographics
NPI:1588004642
Name:HWANG, PHILIP L (OD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:L
Last Name:HWANG
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 1:670 COVEGLEN CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-6800
Mailing Address - Country:US
Mailing Address - Phone:224-392-1766
Mailing Address - Fax:
Practice Address - Street 1:670 COVEGLEN CT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-6800
Practice Address - Country:US
Practice Address - Phone:224-392-1766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002992152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18020046Medicaid
CO18020046Medicaid