Provider Demographics
NPI:1922148261
Name:LIGGINS, PHILLIP M (OD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:M
Last Name:LIGGINS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5711 SARVIS AVE
Mailing Address - Street 2:STE 402
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1365
Mailing Address - Country:US
Mailing Address - Phone:301-277-4844
Mailing Address - Fax:301-927-3221
Practice Address - Street 1:5711 SARVIS AVE
Practice Address - Street 2:STE 402
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1365
Practice Address - Country:US
Practice Address - Phone:301-277-4844
Practice Address - Fax:301-927-3221
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDTA1540152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU74837Medicare UPIN