Provider Demographics
NPI:1669631271
Name:SAMUEL P. SHIPPEE
Entity Type:Organization
Organization Name:SAMUEL P. SHIPPEE
Other - Org Name:SHIPPEE FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHIPPEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:603-788-3561
Mailing Address - Street 1:150 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NH
Mailing Address - Zip Code:03584-3033
Mailing Address - Country:US
Mailing Address - Phone:603-788-3561
Mailing Address - Fax:603-788-5549
Practice Address - Street 1:150 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NH
Practice Address - Zip Code:03584
Practice Address - Country:US
Practice Address - Phone:603-788-3561
Practice Address - Fax:603-788-5549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0768152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHV00819Medicare UPIN
5202090001Medicare NSC
RE7828Medicare PIN