Healthcare Provider Details

I. General information

NPI: 1497994073
Provider Name (Legal Business Name): MR. RICHARD P. RIPPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1097 ROUTE 55 SUITE 1, FREEDOM BUSINESS CENTER
LAGRANGEVILLE NY
12540-5027
US

IV. Provider business mailing address

1097 ROUTE 55 SUITE 1, FREEDOM BUSINESS CENTER
LAGRANGEVILLE NY
12540-5027
US

V. Phone/Fax

Practice location:
  • Phone: 845-471-7710
  • Fax: 845-471-7746
Mailing address:
  • Phone: 845-471-7710
  • Fax: 845-471-7746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License NumberC004055-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberC004055-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: