Robert Lowell Phillips, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC930 Issued in FL

Practice address

534 S 5TH St
Macclenny, FL 32063-2602

Phone

(904) 259-6797

Fax

(904) 259-5230

NPI assigned

Aug 25, 2005

Reactivated

Apr 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Elevated Health & Company, LLC

  • Family Nurse Practitioner
  • Macclenny, FL
  • NPI 1689403677
  NPD (past)

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

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522972800000",
    "number": "1699768689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 886",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320630886",
            "telephone_number": "904-259-6797",
            "fax_number": "904-387-0969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "534 S 5TH ST",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320632602",
            "telephone_number": "904-259-6797",
            "fax_number": "904-259-5230"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1580 Blanding Blvd",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322101834",
            "country_code": "US",
            "telephone_number": "904-387-0025",
            "fax_number": "904-387-0969",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "ROBERT",
        "middle_name": "LOWELL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-25",
        "last_updated": "2018-04-06",
        "deactivation_date": "2006-03-27",
        "reactivation_date": "2006-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OB233",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "084322900",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "084322901",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Merredith Oakes
• Dwayne Maurice Oquendo
• Taylor Parker, APRN
• Linda Ann Parrish, LMFT
• Peter C. Jansen MD
• Physical Therapy and Rehabiitation Clinic Inc
• Cheryl Ruth Pingel, LMHC
• Victoria Christine Pittman, DPT
• Jessica Putney, ARNP
• Amit Ranchhod, PHARM.D

• Optometrist in Macclenny, FL
• Providers in Macclenny, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2018; 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.