Provider Demographics
NPI:1871587592
Name:PHILLIPS, STEPHEN F (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:F
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4537
Mailing Address - Country:US
Mailing Address - Phone:863-299-8908
Mailing Address - Fax:863-299-1061
Practice Address - Street 1:215 1ST ST N
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4537
Practice Address - Country:US
Practice Address - Phone:863-299-8908
Practice Address - Fax:863-299-1061
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC931152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084893000Medicaid
FL084893000Medicaid
FLT85155Medicare UPIN
FL19351XMedicare PIN
FL084893000Medicaid