Provider Demographics
NPI:1720622905
Name:MDPHILLIPSOD PLLC
Entity Type:Organization
Organization Name:MDPHILLIPSOD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DON
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:214-215-4824
Mailing Address - Street 1:9810 ROUND TUIT LN
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:TX
Mailing Address - Zip Code:75407-5411
Mailing Address - Country:US
Mailing Address - Phone:214-215-4824
Mailing Address - Fax:972-423-0454
Practice Address - Street 1:4012 PRESTON RD STE 500
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7351
Practice Address - Country:US
Practice Address - Phone:972-985-3638
Practice Address - Fax:972-867-7062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty