Basic Information
| Provider Information | |||||||||
| NPI: | 1144676610 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHIPPEE FAMILY EYE CARE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 468 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | ST JOHNSBURY | ||||||||
| State: | VT | ||||||||
| PostalCode: | 058199225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022237723 | ||||||||
| FaxNumber: | 8022236313 | ||||||||
| Practice Location | |||||||||
| Address1: | 114 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MONTPELIER | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056023254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022237723 | ||||||||
| FaxNumber: | 8022236313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2016 | ||||||||
| LastUpdateDate: | 09/03/2021 | ||||||||
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| AuthorizedOfficialLastName: | PAYETTE | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8022237723 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.