Provider Demographics
NPI:1104010164
Name:GRIPPO, TOMAS M (MD)
Entity Type:Individual
Prefix:MR
First Name:TOMAS
Middle Name:M
Last Name:GRIPPO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:SHILEY EYE CENTER
Mailing Address - Street 2:9415 CAMPUS POINT DRIVE MC 0946
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093
Mailing Address - Country:US
Mailing Address - Phone:917-679-7782
Mailing Address - Fax:
Practice Address - Street 1:SHILEY EYE CENTER
Practice Address - Street 2:9415 CAMPUS POINT DRIVE, RM 217 MC 0946
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093
Practice Address - Country:US
Practice Address - Phone:917-679-7782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110833207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology