Provider Demographics
NPI:1457339798
Name:PHIFER, JOHN T (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:PHIFER
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:PO BOX 971
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28111-0971
Mailing Address - Country:US
Mailing Address - Phone:704-289-6300
Mailing Address - Fax:704-289-8939
Practice Address - Street 1:510 S SUTHERLAND AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5061
Practice Address - Country:US
Practice Address - Phone:704-289-6300
Practice Address - Fax:704-289-8939
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1089152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909716Medicaid
NC8909716Medicaid
NC0572960001Medicare NSC
NC246386Medicare ID - Type Unspecified