Provider Demographics
NPI:1881687168
Name:PHILLIPS, DAVID EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDWARD
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4801 S CLIFF AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-7015
Mailing Address - Country:US
Mailing Address - Phone:816-478-1230
Mailing Address - Fax:816-478-4413
Practice Address - Street 1:1613 S 7 HWY
Practice Address - Street 2:DICSOVER VISION CENTERS
Practice Address - City:IDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64015
Practice Address - Country:US
Practice Address - Phone:816-478-1230
Practice Address - Fax:816-350-5075
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2273152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00232745OtherRAILROAD MEDICARE
P00232745OtherRAILROAD MEDICARE
T42533Medicare UPIN