Provider Demographics
NPI:1740273002
Name:STRICKLAND, PHILLIP DEAN (OD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:DEAN
Last Name:STRICKLAND
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 1:11391 US HIGHWAY 70 W
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-2205
Mailing Address - Country:US
Mailing Address - Phone:919-553-5600
Mailing Address - Fax:919-553-6707
Practice Address - Street 1:11761 US 70 BUSINESS HWY W # 25
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2274
Practice Address - Country:US
Practice Address - Phone:919-553-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1092152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909156Medicaid
T65119Medicare UPIN
NC8909156Medicaid