Individual
JEFFREY SCOTT PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4504 TEXAS BLVD, TEXARKANA, TX 75503-3027
(903) 792-3705
(903) 794-5008
Mailing address
4504 TEXAS BLVD, TEXARKANA, TX 75503-3027
(903) 792-3705
(903) 794-5008
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5480TG
TX
152WV0400X
Vision Therapy Optometrist
05480TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019156101
TEXAS MEDICAID
TX
05
—
140981722
—
AR
01
—
410046137
RAILROAD MEDICARE
TX
01
—
82857Q
BLUE CROSS BLUE SHIELD
TX
01
—
98441
ARKANSAS BLUE CROSS BLUE
AR
Enumeration date
08/02/2006
Last updated
03/30/2020
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