Provider Demographics
NPI:1679799027
Name:WHITLOW, PHILIP EDWARD (OD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:EDWARD
Last Name:WHITLOW
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 1:1313 LAWTON
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-3636
Mailing Address - Country:US
Mailing Address - Phone:405-691-4111
Mailing Address - Fax:405-691-4168
Practice Address - Street 1:1313 LAWTON
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3636
Practice Address - Country:US
Practice Address - Phone:405-691-4111
Practice Address - Fax:405-691-4168
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK 1066152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist