Provider Demographics
NPI:1952752982
Name:WHITEHEAD, PHILLIP ANDREW (OD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ANDREW
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:DREW
Other - Middle Name:
Other - Last Name:WHITEHEAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:708 HILL COUNTRY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-6071
Mailing Address - Country:US
Mailing Address - Phone:830-257-5656
Mailing Address - Fax:
Practice Address - Street 1:708 HILL COUNTRY DR STE 100
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6071
Practice Address - Country:US
Practice Address - Phone:830-257-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8950T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist