Provider Demographics
NPI:1376522417
Name:RIPLEY, DAVID GLEN (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GLEN
Last Name:RIPLEY
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 1:16 EAST ST
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-3832
Mailing Address - Country:US
Mailing Address - Phone:802-476-2020
Mailing Address - Fax:802-476-4818
Practice Address - Street 1:16 EAST ST
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-3832
Practice Address - Country:US
Practice Address - Phone:802-476-2020
Practice Address - Fax:802-476-4818
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTVT 232152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTT25459Medicare UPIN
VTVT9045Medicare ID - Type Unspecified