Provider Demographics
NPI:1497994073
Name:RIPPA, RICHARD P
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:P
Last Name:RIPPA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1097 ROUTE 55
Mailing Address - Street 2:SUITE 1, FREEDOM BUSINESS CENTER
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5027
Mailing Address - Country:US
Mailing Address - Phone:845-471-7710
Mailing Address - Fax:845-471-7746
Practice Address - Street 1:1097 ROUTE 55
Practice Address - Street 2:SUITE 1, FREEDOM BUSINESS CENTER
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-5027
Practice Address - Country:US
Practice Address - Phone:845-471-7710
Practice Address - Fax:845-471-7746
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC004055-1156FC0801X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0476390001Medicare NSC