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General NPI Number Information
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NPI Number | 1740225077
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Entity Type | Individual
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Provider Name | STEPHANIE R SIPE OD
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Gender | Female
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4503 OCEAN BEACH HWY STE 103
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City | LONGVIEW
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State | WA
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Zip | 98632-5055
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Country | US
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Telephone | 360-636-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 24312 NE 142ND AVE
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City | BATTLE GROUND
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State | WA
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Zip | 98604-9412
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Country | US
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Telephone | 503-504-2182
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OD00004012
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License Number State | WA
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