Provider Demographics
NPI:1790822179
Name:SHIPPEE, KARENA (OD)
Entity Type:Individual
Prefix:
First Name:KARENA
Middle Name:
Last Name:SHIPPEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-9225
Mailing Address - Country:US
Mailing Address - Phone:802-748-3536
Mailing Address - Fax:
Practice Address - Street 1:468 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-9225
Practice Address - Country:US
Practice Address - Phone:802-748-3536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030-0000332152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN3502Medicaid
VTOVN3502Medicaid
VTY17767Medicare UPIN
VTVN3502Medicare PIN