Provider Demographics
NPI:1144373689
Name:PHILLIPS, MICHAEL DON (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DON
Last Name:PHILLIPS
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 1:811 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 1005
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-8815
Mailing Address - Country:US
Mailing Address - Phone:972-633-5000
Mailing Address - Fax:972-423-0454
Practice Address - Street 1:811 N CENTRAL EXPY
Practice Address - Street 2:SUITE 1005
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8815
Practice Address - Country:US
Practice Address - Phone:972-633-5000
Practice Address - Fax:972-423-0454
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02498T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX911692OtherEYEMED
00Z239OtherMEDICARE PTAN GROUP
TX8L9534OtherMEDICARE PTAN INDIVIDUAL
TXU25146Medicare UPIN
TX8A4600Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #