Most Relevant Information
Provider Data
| NPI Number: | 1003595422 |
| Provider Name: | NIA PHILLIPS O.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 152W00000X |
| Specialty: | Optometrist |
| License Number: | OEG004049 |
Most Important Dates
| Enumeration Date: | 07/13/2023 |
| Last Updated: | 07/13/2023 |
Provider Practice Location
1200 W GODFREY AVE
PHILADELPHIA
PA
191413323
Practice Location Phone/Fax
| Phone: | 2152766000 |
| Fax: | 2152766096 |
Provider Mailing Location
1200 W GODFREY AVE
PHILADELPHIA
PA
191413323
Provider Mailing Phone/Fax
| Phone: | 2152766000 |
| Fax: | 2152766096 |