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Individual
WALLACE L PHILLIPS
Active
Individual
WALLACE L PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2869TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00E80D
BLUE CROSS/BLUE SHIELD
—
05
—
032932801
—
TX
Enumeration date
10/02/2006
Last updated
07/06/2010
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