Provider Demographics
NPI:1801095377
Name:TABOR, PHILLIP CARL JR (OD)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:CARL
Last Name:TABOR
Suffix:JR
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:OK
Mailing Address - Zip Code:73030-1747
Mailing Address - Country:US
Mailing Address - Phone:580-369-3937
Mailing Address - Fax:
Practice Address - Street 1:119W MAIN ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:OK
Practice Address - Zip Code:73030-1747
Practice Address - Country:US
Practice Address - Phone:580-369-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2870152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist