Provider Demographics
NPI:1164115697
Name:ZIPPRICH, MISTY
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:ZIPPRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-1251
Mailing Address - Country:US
Mailing Address - Phone:217-352-1812
Mailing Address - Fax:217-403-1769
Practice Address - Street 1:2610 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-1251
Practice Address - Country:US
Practice Address - Phone:217-352-1812
Practice Address - Fax:217-403-1769
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician