Provider Demographics
NPI:1346222403
Name:SIPE, RICKEY L (OD)
Entity Type:Individual
Prefix:DR
First Name:RICKEY
Middle Name:L
Last Name:SIPE
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 399
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-0399
Mailing Address - Country:US
Mailing Address - Phone:336-945-3716
Mailing Address - Fax:336-945-3001
Practice Address - Street 1:6758 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27023-9724
Practice Address - Country:US
Practice Address - Phone:336-945-3716
Practice Address - Fax:336-945-3001
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC881152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCT64765Medicare UPIN
NC246213AMedicare PIN