Provider Demographics
NPI:1588640908
Name:STILES, PHILIP B (OD)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:B
Last Name:STILES
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 1:2810 E TRINITY MILLS RD
Mailing Address - Street 2:#173
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-2545
Mailing Address - Country:US
Mailing Address - Phone:972-416-1270
Mailing Address - Fax:972-416-4839
Practice Address - Street 1:2810 E TRINITY MILLS RD
Practice Address - Street 2:#173
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-2545
Practice Address - Country:US
Practice Address - Phone:972-416-1270
Practice Address - Fax:972-416-4839
Is Sole Proprietor?:No
Enumeration Date:2005-12-17
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3226TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81504QOtherBCBS
TX81504QOtherBCBS
8F8431Medicare UPIN