Provider Demographics
NPI:1104826528
Name:VITO, PHILLIP M (OD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:M
Last Name:VITO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:608 HOLLY SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-9030
Mailing Address - Country:US
Mailing Address - Phone:919-577-3937
Mailing Address - Fax:919-577-9260
Practice Address - Street 1:608 HOLLY SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-9030
Practice Address - Country:US
Practice Address - Phone:919-577-3937
Practice Address - Fax:919-577-9260
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC 1652152W00000X
NJ4872152W00000X
PA6828152W00000X
NC1652152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890905JMedicaid
NCT84845Medicare UPIN
NC890905JMedicaid