Wise, Phillip Lee
Wise, Phillip Lee is an individual health care provider with primary practice located at 326 N Broad St , Selinsgrove PA 17870-1512. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Wise, Phillip Lee can be contacted via phone (570) 374-8136.Contact Information
Primary practice address
326 N Broad St
Selinsgrove PA 17870-1512
Phone: (570) 374-8136
Fax: (570) 374-0462
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | OEG001746 | Pennsylvania |
Profile Details
| NPI number | 1558344705 |
|---|---|
| LBN Legal business name | Wise, Phillip Lee |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 22nd, 2005 |
| Last updated | Apr 17th, 2008 - about 16 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 | 1558344705 | NPPES |
| Pennsylvania | MEDICAID | 0012999200001 | |
| Pennsylvania | Other | 02549200 | |
| Pennsylvania | Other | T28746 |
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