Individual
DR. JERRY LYNN PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2864 WILLAMETTE ST, SUITE 600, EUGENE, OR 97405-3297
(541) 689-2881
Mailing address
2423 PANORAMA DR, EUGENE, OR 97405-1481
(541) 729-4778
(541) 484-7674
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2681 ATI
OR
332H00000X
Eyewear Supplier
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
295849
—
OR
Enumeration date
05/15/2006
Last updated
03/01/2020
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