Provider Demographics
NPI:1700962743
Name:HANDLEY, PHILLIP STANCIL (OD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:STANCIL
Last Name:HANDLEY
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:PO BOX 828
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:AL
Mailing Address - Zip Code:35051-0828
Mailing Address - Country:US
Mailing Address - Phone:205-669-4131
Mailing Address - Fax:205-669-4737
Practice Address - Street 1:112 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:AL
Practice Address - Zip Code:35051
Practice Address - Country:US
Practice Address - Phone:205-669-4131
Practice Address - Fax:205-669-4737
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-432-TA-044152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051503452OtherBCBS
AL000075021Medicaid
AL000075021Medicaid