WALLACE L PHILLIPS (NPI# 1457444580) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457444580 |
| Entity Type | Individual |
| Full Name | WALLACE L PHILLIPS |
| Credential | O.D. |
| Practice Address |
103 S East Ave Kermit TX 79745-3606 |
| Practice Telephone | 4325863435 |
| Practice Fax Number | 4325866737 |
| Mailing Telephone | 4325863435 |
| Mailing Fax Number | 4325866737 |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2010-07-06 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 2869TG | TX | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BLUE CROSS/BLUE SHIELD | 00E80D | 01 | |
| TX | 032932801 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528166717 | Wallace Scott Phillips | Nurse Anesthetist, Certified Registered | 1031 Scott Ter, Athens, GA 30606-6271 | 2006-09-20 |
| Street Address |
103 S EAST AVE |
| City | KERMIT |
| State | TX |
| Zip Code | 79745-3606 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508218686 | Ryan Phillips | Optometrist | 103 S East Ave, Kermit, TX 79745-3606 | 2016-07-12 |
| 1003040452 | Wallace L Phillips | Optometrist | 103 S East Ave, Kermit, TX 79745-3606 | 2009-05-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013052760 | Daniel Lawrence Desilets | Dentist | 602 E Campbell, Kermit, TX 79745 | 2007-02-20 |
| 1114924164 | Winkler County Hospital District | Emergency Medicine | 821 Jeffee Drive, Kermit, TX 79745 | 2005-07-06 |
| 1285637520 | Stanly T Selby | Family Medicine | 821 Jeffee Dr Annex A, Kermit, TX 79745 | 2005-05-31 |
| 1679953517 | Amanda Compton | Family Medicine | 828 Myer Ln, Kermit, TX 79745 | 2015-06-05 |
| 1851591200 | Jvhd LLC | Pharmacy | 810 Myer Ln, Kermit, TX 79745 | 2007-07-24 |
| 1487714622 | Pay and Save Inc | Pharmacy | 310 E Austin St, Kermit, TX 79745-3023 | 2006-12-11 |
| 1184755324 | Sohrab Azima | Pharmacist | 310 E Austin St, Kermit, TX 79745-3023 | 2007-03-08 |
| 1316051352 | John Judson Graves | Dentist | 402 E Austin St, Kermit, TX 79745-3222 | 2006-08-18 |
| 1821484932 | Viral Patel Dental PC | Dentist | 402 E Austin St, Kermit, TX 79745-3222 | 2015-04-15 |
| 1548741168 | Sherry Lynn Ellis | Licensed Vocational Nurse | 909 Underwood St, Kermit, TX 79745-4524 | 2018-08-22 |
| Find all providers in zip 79745 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508218686 | Ryan Phillips | Optometrist | 103 S East Ave, Kermit, TX 79745-3606 | 2016-07-12 |
| 1003040452 | Wallace L Phillips | Optometrist | 103 S East Ave, Kermit, TX 79745-3606 | 2009-05-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265033690 | Daniel, Max & Marcandrea, LLC | Optometrist | 9475 Fm 1960, Humble, TX 77338 | 2020-11-03 |
| 1548861164 | Daniel & Max, LLC | Optometrist | 3110 N Loop 250 W, Suite 200, Midland, TX 79707 | 2020-11-02 |
| 1750981684 | Joel George | Optometrist | 6418 Eckhert Rd Apt 4206, San Antonio, TX 78240-3142 | 2020-10-29 |
| 1104425743 | Lara Fady | Optometrist | 13614 Meridian Springs Ln, Houston, TX 77077-2123 | 2020-10-24 |
| 1295334001 | Eye Room Pllc | Optometrist | 17659 Fishtrap Road, Ste 30, Prosper, TX 75078-7507 | 2020-10-22 |
| 1699374538 | Daniel Max & Marc Andrea LLC | Optometrist | 1051 Silber Rd, Houston, TX 77055-7134 | 2020-10-21 |
| 1922607902 | Glimpse Eye Care | Optometrist | 26435 Kuykendahl Rd Ste 800, Tomball, TX 77375-1855 | 2020-10-21 |
| 1831798016 | Birds Eye View Optometry - League City Pllc | Optometrist | 1355 E League City Pkwy Ste 200, League City, TX 77573-7095 | 2020-10-20 |
| 1720687056 | Judy Hoang | Optometrist | 8910 Bandera Rd Ste 105, San Antonio, TX 78250-3227 | 2020-10-19 |
| 1922607274 | Danielle Nimeh | Optometrist | 6636 Lake Worth Blvd Ste 300, Lake Worth, TX 76135-3029 | 2020-10-19 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.