Provider Demographics
NPI:1427897206
Name:PHILLIPS, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 FISHER POND RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-6058
Mailing Address - Country:US
Mailing Address - Phone:802-524-9561
Mailing Address - Fax:802-524-6060
Practice Address - Street 1:128 FISHER POND RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-6058
Practice Address - Country:US
Practice Address - Phone:802-524-9561
Practice Address - Fax:802-524-6060
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030.0134029152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty