MEDICARE: DAVID GLEN RIPLEY O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	VT 232	VT

General Provider Information

NPI Number	:	1376522417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID GLEN RIPLEY O.D.

Provider Business Mailing Address
First Line	:	16 EAST ST
Second Line	:
City	:	BARRE
State	:	VT
Zip	:	05641-3832
Country	:	US
Telephone Number	:	802-476-2020
Fax Number	:	802-476-4818

Provider Business Practice Location Address
First Line	:	16 EAST ST
Second Line	:
City	:	BARRE
State	:	VT
Zip	:	05641-3832
Country	:	US
Telephone Number	:	802-476-2020
Fax Number	:	802-476-4818

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2006
Last Update Date	:	01/05/2010

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