Provider Demographics
NPI:1104412790
Name:DEMOTT, PHILLIP (OD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:DEMOTT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 HERRING RUN RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-5795
Mailing Address - Country:US
Mailing Address - Phone:302-629-6691
Mailing Address - Fax:
Practice Address - Street 1:8500 HERRING RUN RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-5795
Practice Address - Country:US
Practice Address - Phone:302-629-6691
Practice Address - Fax:302-629-7963
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI3-0011428207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology