Provider Demographics
NPI:1518527274
Name:ZIPPI, BLAKE OAKLEY (OD)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:OAKLEY
Last Name:ZIPPI
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 1:402 S ARMENIA AVE UNIT 139C
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3399
Mailing Address - Country:US
Mailing Address - Phone:321-213-2360
Mailing Address - Fax:
Practice Address - Street 1:3108 N BOUNDARY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33621-5050
Practice Address - Country:US
Practice Address - Phone:813-840-2292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-15
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003587152W00000X
FLOPC5781152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program