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General NPI Number Information
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NPI Number | 1023407467
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Entity Type | Organization
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Legal Business Name | SHIPPEE FAMILY EYE CARE PC
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Dates
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Enumeration Date | 01/22/2015
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 468 HOSPITAL DR
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City | ST JOHNSBURY
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State | VT
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Zip | 05819-9225
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Country | US
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Telephone | 802-748-3536
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Fax | 802-748-4838
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Provider Business Mailing Address
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Address Line | 468 HOSPITAL DR
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City | ST JOHNSBURY
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State | VT
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Zip | 05819-9225
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Country | US
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Telephone | 802-748-3536
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Fax | 802-748-4838
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Authorized Official
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Title or Position | OWNER/AUTHORIZED OFFICIAL
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Name | DR. SAMUEL P SHIPPEE
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Credential | OD
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Telephone | 603-788-3561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 300000331
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License Number State | VT
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