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General NPI Number Information
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NPI Number | 1316235120
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Entity Type | Organization
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Legal Business Name | I & T WHIPPLE PLLC
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Dates
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Enumeration Date | 07/13/2011
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 2126 PEBBLEBROOK RD
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City | PLEASANT VIEW
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State | UT
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Zip | 84404-2808
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Country | US
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Telephone | 208-534-8488
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Fax |
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Provider Business Mailing Address
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Address Line | 2126 PEBBLEBROOK RD
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City | PLEASANT VIEW
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State | UT
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Zip | 84404-2808
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. IAN WHIPPLE
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Credential | O.D.
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Telephone | 208-534-8488
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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 | ODP-100236
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License Number State | ID
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