Dr. Philip M Brock, OD
Optometrist in Crossville, TN. Individual provider (NPI-1).
NPI number1043078611
StatusActive
Last updated in NPPESJun 25, 2024
Details
- NPI
- 1043078611
- Entity type
- Individual (NPI-1)
- Name
- Dr. Philip M Brock
- Credential
- OD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 8, 2024
- Certification date
- Jun 25, 2024
- Last updated
- Jun 25, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 3881 | TN | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
15 Iris LnCrossville, TN 38555-7528
Phone 931-456-2728 · Fax 931-456-5446
Mailing address
15 Iris LnCrossville, TN 38555-7528
Phone 931-456-2728 · Fax 931-456-5446
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All 8 Optometrist providers in Crossville · All 758 providers in Crossville
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