Provider Demographics
NPI:1134323678
Name:DRS. CRIPE, STEPHENS & STICKEL LLP
Entity Type:Organization
Organization Name:DRS. CRIPE, STEPHENS & STICKEL LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:STEFAN
Authorized Official - Last Name:STICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:574-533-4141
Mailing Address - Street 1:1722 BASHOR RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-1302
Mailing Address - Country:US
Mailing Address - Phone:574-533-4141
Mailing Address - Fax:574-534-2278
Practice Address - Street 1:1722 BASHOR RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-1302
Practice Address - Country:US
Practice Address - Phone:574-533-4141
Practice Address - Fax:574-534-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1876152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4166110001Medicare NSC