Individual
KENNETH A PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
314 HONESDALE ROAD, WAYMART, PA 18472-0310
(570) 488-6710
Mailing address
PO BOX 310, WAYMART, PA 18472-0310
(570) 488-6710
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG000530
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
075457
FIRST PRIORITY
PA
01
—
0829700
AETNA
PA
01
—
18765
GEISINGER
PA
01
—
390770
NVA
PA
01
—
OEG000530
VBA
PA
01
—
PH289044
CLARITY VISION
PA
Enumeration date
11/21/2006
Last updated
07/01/2010
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