Phillips, Jerry Lynn
Phillips, Jerry Lynn is an sole proprietor health care provider with primary practice located at 2864 Willamette St Suite 600, Eugene OR 97405-3297. He recently has 2 registered licenses in different health care specialties including Suppliers / Eyewear Supplier (Equipment, not the service), Eye and Vision Services Providers / Optometrist. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Phillips, Jerry Lynn can be contacted via phone (541) 689-2881.Contact Information
Primary practice address
2864 Willamette St Suite 600
Eugene OR 97405-3297
Phone: (541) 689-2881
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Eyewear Supplier (Equipment, not the service) | 332H00000X | Oregon | |
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2681 ATI | Oregon |
Profile Details
| NPI number | 1134170905 |
|---|---|
| LBN Legal business name | Phillips, Jerry Lynn |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 15th, 2006 |
| Last updated | Mar 1st, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1134170905 | NPPES |
| Oregon | MEDICAID | 295849 |
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