Organization
ONE SOURCE VISION CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID N PHILLIPS O.D. (PRESIDENT)
(812) 897-8900
Entity
Organization
Contact information
Practice address
966 AIGNER DR, BOONVILLE, IN 47601-8471
(812) 897-8900
(801) 218-0060
Mailing address
966 AIGNER DR, BOONVILLE, IN 47601-8471
(812) 897-8900
(801) 218-0060
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001663A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100254340
—
IN
Enumeration date
08/04/2010
Last updated
09/17/2012
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