Healthcare Provider Details

I. General information

NPI: 1861543571
Provider Name (Legal Business Name): TIPP EYE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S TIPPECANOE DR
TIPP CITY OH
45371-1194
US

IV. Provider business mailing address

115 S TIPPECANOE DR
TIPP CITY OH
45371-1194
US

V. Phone/Fax

Practice location:
  • Phone: 937-667-1270
  • Fax: 937-667-7198
Mailing address:
  • Phone: 937-667-1270
  • Fax: 937-667-7198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4140
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3282
License Number StateOH

VIII. Authorized Official

Name: MR. JAMES R RANFT
Title or Position: CO-OWNER
Credential: O.D.
Phone: 937-667-1270