Wallace L Phillips, OD is a medicare enrolled "Optometrist" provider in Kermit, Texas. His current practice location is
103 S East Ave, Kermit, Texas. You can reach out to his office (for appointments etc.) via phone at
(432) 586-3435.
Wallace L Phillips is licensed to practice in Texas (license number 2869TG) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1457444580.
Healthcare Provider's Profile
| Full Name | Wallace L Phillips |
|---|
| Gender | Male |
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| Speciality | Optometrist |
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| Location | 103 S East Ave, Kermit, Texas |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1457444580
- Provider Enumeration Date: 10/02/2006
- Last Update Date: 07/06/2010
Medicare PECOS Information:
- PECOS PAC ID: 7113035817
- Enrollment ID: I20101101000025
Medical Identifiers
Medical identifiers for Wallace L Phillips such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1457444580 | NPI | - | NPPES |
| 00E80D | Other | | BLUE CROSS/BLUE SHIELD |
| 032932801 | Medicaid | TX | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 152W00000X | Optometrist | 2869TG (Texas) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Wallace L Phillips is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
Wallace L Phillips, OD 103 S East Ave, Kermit, TX 79745-3606 Ph: (432) 586-3435 | Wallace L Phillips, OD 103 S East Ave, Kermit, TX 79745-3606 Ph: (432) 586-3435 |
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