Healthcare Provider Details

I. General information

NPI: 1508845025
Provider Name (Legal Business Name): SAMUEL PATRICK SHIPPEE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MAIN ST
LANCASTER NH
03584-3033
US

IV. Provider business mailing address

114 MAIN ST
MONTPELIER VT
05602-3254
US

V. Phone/Fax

Practice location:
  • Phone: 603-788-3561
  • Fax: 603-788-5549
Mailing address:
  • Phone: 802-223-7723
  • Fax: 802-223-6313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number030.000331
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0768
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: