Organization
TEXAS STATE OPTICAL OF BRYAN PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERALD D PHILLIPS (DOCTOR)
(979) 731-8446
Entity
Organization
Contact information
Practice address
3030 E 29TH ST, SUITE 106, BRYAN, TX 77802-2757
(979) 731-8446
Mailing address
3030 E 29TH ST, SUITE 106, BRYAN, TX 77802-2757
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112311903
—
TX
01
—
16110
SPECTERA
TX
01
—
16258
SCOTT & WHITE
TX
01
—
59496
SAFEGUARD
TX
01
—
6271
AVESIS
TX
01
—
80323E
BLUE CROSS BLUE SHIELD
TX
01
—
902303
BLOCK VISION
TX
01
—
TX2145
EYEMED
TX
Enumeration date
12/04/2007
Last updated
10/03/2008
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