| |
103 S East Ave, Kermit, TX 79745-3606 | |
(432) 586-3435 | |
(432) 586-6737 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 103 S East Ave, Kermit, Texas |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1003040452 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 2869TG (Texas) | Primary |
Mailing Address | Practice Location Address |
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103 S East Ave, Kermit, TX 79745-3606 Ph: (432) 586-3435 | 103 S East Ave, Kermit, TX 79745-3606 Ph: (432) 586-3435 |
Wallace L Phillips, O.D. Optometrist Medicare: May Accept Medicare Assignments Practice Location: 103 S East Ave, Kermit, TX 79745 Phone: 432-586-3435 Fax: 432-586-6737 |