Basic Information
| Provider Information | |||||||||
| NPI: | 1528011244 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LABOR | ||||||||
| FirstName: | PHILLIPS | ||||||||
| MiddleName: | KIRK | ||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2201 WESTGATE PLAZA | ||||||||
| Address2: | |||||||||
| City: | GRAPEVINE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174102030 | ||||||||
| FaxNumber: | 8172516261 | ||||||||
| Practice Location | |||||||||
| Address1: | 2201 WESTGATE PLAZA | ||||||||
| Address2: | |||||||||
| City: | GRAPEVINE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174102030 | ||||||||
| FaxNumber: | 8172516261 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 06/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | K7044 | TX | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 15470333 | 01 | TX | PACIFICARE PIN | OTHER | 8A2214 | 01 | TX | BCBS PIN | OTHER | 5456201 | 01 | TX | AETNA PIN | OTHER | 3977274 | 01 | TX | CIGNA PIN | OTHER |