Provider Demographics
NPI:1578613451
Name:RIPPNER, THOMAS F (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:RIPPNER
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 1:1270 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2856
Mailing Address - Country:US
Mailing Address - Phone:805-541-1342
Mailing Address - Fax:805-541-5836
Practice Address - Street 1:1270 PEACH ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2856
Practice Address - Country:US
Practice Address - Phone:805-541-1342
Practice Address - Fax:805-541-5836
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT4852152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0048520Medicaid
CAWOP4852HMedicare ID - Type UnspecifiedSANTA MARIA
CAWOP4852FMedicare ID - Type UnspecifiedCAMBRIA
CASD0048520Medicaid
CAT09798Medicare UPIN
CAWOP4852EMedicare ID - Type UnspecifiedARROYO GRANDE
CAWOP4852GMedicare ID - Type UnspecifiedTEMPLETON