Provider Demographics
NPI:1912213174
Name:FRIPPS, MIA N (OD)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:N
Last Name:FRIPPS
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:1010 BROOK ROAD
Mailing Address - Street 2:SUITE 852A
Mailing Address - City:GLENN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-6523
Mailing Address - Country:US
Mailing Address - Phone:804-266-9511
Mailing Address - Fax:804-266-3871
Practice Address - Street 1:1010 BROOK ROAD
Practice Address - Street 2:SUITE 852A
Practice Address - City:GLENN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-6523
Practice Address - Country:US
Practice Address - Phone:804-266-9511
Practice Address - Fax:804-266-3871
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0618001941152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist