Provider Demographics
NPI:1780845339
Name:TRIPP, ROBERT F (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:TRIPP
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 1:1208 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5430
Mailing Address - Country:US
Mailing Address - Phone:318-322-2020
Mailing Address - Fax:318-387-4242
Practice Address - Street 1:1208 N 18TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5430
Practice Address - Country:US
Practice Address - Phone:318-322-2020
Practice Address - Fax:318-387-4242
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA879-177T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist