Healthcare Provider Details

I. General information

NPI: 1285741454
Provider Name (Legal Business Name): STEVEN ANTHONY CIPPARONE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 ROUTE 42
TURNERSVILLE NJ
08012-1752
US

IV. Provider business mailing address

111 PREAKNESS DR
MULLICA HILL NJ
08062-3603
US

V. Phone/Fax

Practice location:
  • Phone: 856-629-4207
  • Fax: 856-629-4261
Mailing address:
  • Phone: 856-906-6079
  • Fax: 856-629-4261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOA005489
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000338
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTO00919
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: