Provider Demographics
NPI:1942296413
Name:SHIPLE, JENNIFFER (OD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFFER
Middle Name:
Last Name:SHIPLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JENNIFFER
Other - Middle Name:
Other - Last Name:HEINTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 ORLAND SQUARE DR
Mailing Address - Street 2:PEARLE VISION
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3207
Mailing Address - Country:US
Mailing Address - Phone:708-403-3555
Mailing Address - Fax:708-403-6602
Practice Address - Street 1:24 ORLAND SQUARE DR
Practice Address - Street 2:PEARLE VISION
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3207
Practice Address - Country:US
Practice Address - Phone:708-403-3555
Practice Address - Fax:708-403-6602
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009040152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U80576Medicare UPIN