Provider Demographics
NPI:1992005938
Name:DR. JEFFREY TIPTON OD PC
Entity Type:Organization
Organization Name:DR. JEFFREY TIPTON OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-728-4569
Mailing Address - Street 1:3162 W 1100 N
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:UT
Mailing Address - Zip Code:84015-7571
Mailing Address - Country:US
Mailing Address - Phone:801-728-4569
Mailing Address - Fax:
Practice Address - Street 1:1055 W HILL FIELD RD
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4614
Practice Address - Country:US
Practice Address - Phone:801-510-1541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT348415-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529080999001Medicaid
UT000012555Medicare PIN
UTU82109Medicare UPIN