Provider Demographics
NPI:1013298165
Name:TAWIL, PHILIP (OD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:TAWIL
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 1:1415 VALENCIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3716
Mailing Address - Country:US
Mailing Address - Phone:415-814-2564
Mailing Address - Fax:
Practice Address - Street 1:2049 OAK ST APT 1
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1822
Practice Address - Country:US
Practice Address - Phone:415-431-2988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11755T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist