NPIMap

Organization Active NPI

Wallace L Phillips

  • Optometrist
  • Kermit, TX
National Provider Identifier
1003040452
Registry record updated May 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2869TG Issued in TX
Legal business name
WALLACE L PHILLIPS
Practice address
103 S East Ave
Kermit, TX 79745-3606
Phone
(432) 586-3435
Fax
(432) 586-6737
NPI assigned
May 13, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Wallace L Phillips, O.D.
Title
Owner
Phone
(432) 586-3435

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2869TG TX Primary

Addresses

Primary practice location

103 S East Ave
Kermit, TX 79745-3606

Mailing address

103 S East Ave
Kermit, TX 79745-3606
Phone (432) 586-3435

Other names 1

  • Phillips Eye Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

103 S East Ave
Kermit, TX 79745
Phone (432) 586-3435

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242172800000",
    "number": "1003040452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 S EAST AVE",
            "city": "KERMIT",
            "state": "TX",
            "postal_code": "797453606",
            "telephone_number": "432-586-3435",
            "fax_number": "432-586-6737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 S EAST AVE",
            "city": "KERMIT",
            "state": "TX",
            "postal_code": "797453606",
            "telephone_number": "432-586-3435",
            "fax_number": "432-586-6737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE L PHILLIPS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-13",
        "last_updated": "2009-05-13",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "WALLACE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "432-586-3435",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TX",
            "license": "2869TG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phillips Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kermit, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.