Individual
PHILLIP LEE WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG001746
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012999200001
—
PA
01
—
02549200
CAPITAL BLUE CROSS
PA
01
—
T28746
HEALTH ASSURANCE
PA
Enumeration date
11/22/2005
Last updated
04/17/2008
Update your record
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