Individual
DR. PHILLIP LEE GILLIAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
114 S SYCAMORE ST, ELIZABETHTON, TN 37643-3339
(423) 543-3421
(423) 543-7099
Mailing address
2103 CAMELOT CIR, JOHNSON CITY, TN 37604-2932
(423) 854-9210
(423) 854-9210
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1262
TN
152W00000X
Optometrist
OD1262
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
910711
EYEMED INSURANCE PROVIDER
TN
05
—
Q019840
—
TN
Enumeration date
02/23/2007
Last updated
10/30/2018
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