Provider Demographics
NPI:1023407467
Name:SHIPPEE FAMILY EYE CARE PC
Entity type:Organization
Organization Name:SHIPPEE FAMILY EYE CARE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHIPPEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:603-788-3561
Mailing Address - Street 1:468 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-9225
Mailing Address - Country:US
Mailing Address - Phone:802-748-3536
Mailing Address - Fax:802-748-4838
Practice Address - Street 1:468 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-9225
Practice Address - Country:US
Practice Address - Phone:802-748-3536
Practice Address - Fax:802-748-4838
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHIPPEE FAMILY EYE CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-22
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT300000331152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1016148Medicaid
VT6291050002Medicare NSC