Provider Demographics
NPI:1619382124
Name:PHILIP, BLESSY (OD)
Entity Type:Individual
Prefix:DR
First Name:BLESSY
Middle Name:
Last Name:PHILIP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 STATE HIGHWAY 121 BYP
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-4158
Mailing Address - Country:US
Mailing Address - Phone:972-315-9306
Mailing Address - Fax:
Practice Address - Street 1:851 STATE HIGHWAY 121 BYP
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4158
Practice Address - Country:US
Practice Address - Phone:972-315-9306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8432T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist