Healthcare Provider Details

I. General information

NPI: 1003651324
Provider Name (Legal Business Name): HEATHER NOEL CIPPERLY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200S UNIVERSITY DR TERRY BUILDING 1402
DAVIE FL
33328-2018
US

IV. Provider business mailing address

PO BOX 290370
DAVIE FL
33329-0370
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-4235
  • Fax: 954-262-3904
Mailing address:
  • Phone: 954-262-4397
  • Fax: 954-262-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPC6502
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: