Provider Demographics
NPI:1437467859
Name:SHIPLEY, MARGOT (OD)
Entity type:Individual
Prefix:DR
First Name:MARGOT
Middle Name:
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 GUERNEVILLE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-4158
Mailing Address - Country:US
Mailing Address - Phone:707-525-9920
Mailing Address - Fax:
Practice Address - Street 1:1430 GUERNEVILLE RD STE 3
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-4158
Practice Address - Country:US
Practice Address - Phone:707-525-9920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT14078TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14078TLGOtherSTATE BOARD