Provider Demographics
NPI:1093815367
Name:SHIPPEE, DAVID J (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:SHIPPEE
Suffix:
Gender:M
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:PO BOX 1048
Mailing Address - Street 2:178 CENTRAL ST
Mailing Address - City:MILLINOCKET
Mailing Address - State:ME
Mailing Address - Zip Code:04462
Mailing Address - Country:US
Mailing Address - Phone:207-723-5376
Mailing Address - Fax:207-723-9074
Practice Address - Street 1:178 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:MILLINOCKET
Practice Address - State:ME
Practice Address - Zip Code:04462
Practice Address - Country:US
Practice Address - Phone:207-723-5376
Practice Address - Fax:207-723-9074
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT573152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME107890001Medicaid
MESH710261Medicare ID - Type Unspecified
T79610Medicare UPIN
ME107890001Medicaid