Philip Gilbert Cromwell, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1109189934 Issued in UT

Practice address

134 N State St
Suite a
Preston, ID 83263-1143

Phone

(208) 852-3030

Fax

(208) 852-3031

NPI assigned

Aug 22, 2006

Last updated

Feb 16, 2012By the provider in NPPES

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

Enrolled in ID, UT2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eye Care for You LLC

  • Optometrist
  • Preston, ID
  • NPI 1548405327
  Medicare reassignment Authorized official
• Eye Care for You LLC

  • Optometrist
  • Logan, UT
  • NPI 1619112398
  Medicare reassignment Authorized official
• Eye Care for You, P.C.

  • Optometrist
  • Preston, ID
  • NPI 1457418253
  NPD (past) Authorized official
• MKG Enterprises

  • Ophthalmology Physician
  • Tooele, UT
  • NPI 1457538043
  NPD (past)

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329350400000",
    "number": "1720194632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 N STATE ST",
            "address_2": "SUITE A",
            "city": "PRESTON",
            "state": "ID",
            "postal_code": "832631143",
            "telephone_number": "208-852-3030",
            "fax_number": "208-852-3031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 N STATE ST",
            "address_2": "SUITE A",
            "city": "PRESTON",
            "state": "ID",
            "postal_code": "832631143",
            "telephone_number": "208-852-3030",
            "fax_number": "208-852-3031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROMWELL",
        "first_name": "PHILIP",
        "middle_name": "GILBERT",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2012-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP607",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "1109189934",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1720194632",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1720194632",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heidi Carter, LMSW
• Justin Carter, DDS
• Stacey Cooper
• County of Franklin (Franklin County Ambulance)
• David Alvord Cox, D.C.
• Shannon Crowther, RDN
• Corby M Dixon
• Dr. Jason B. Welker, D.C. P.C.
• Alyssa Dyer, LMSW
• Michael David Earley, DC

• Optometrist in Preston, ID
• Providers in Preston, ID by specialty
• Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.