Provider Demographics
NPI:1740256841
Name:MEREDITH, PHILLIP (OD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:MEREDITH
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 1:1651 GLENNS BAY RD
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-4836
Mailing Address - Country:US
Mailing Address - Phone:843-650-2400
Mailing Address - Fax:843-699-2227
Practice Address - Street 1:1651 GLENNS BAY RD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-4836
Practice Address - Country:US
Practice Address - Phone:843-650-2400
Practice Address - Fax:843-699-2227
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1028152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD10281Medicaid
SCU67160Medicare UPIN