Individual
DR. PHILIP GILBERT CROMWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
134 N STATE ST, SUITE A, PRESTON, ID 83263-1143
(208) 852-3030
(208) 852-3031
Mailing address
134 N STATE ST, SUITE A, PRESTON, ID 83263-1143
(208) 852-3030
(208) 852-3031
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1109189934
UT
152W00000X
Optometrist
ODP607
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720194632
—
ID
05
—
1720194632
—
UT
Enumeration date
08/22/2006
Last updated
02/16/2012
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