Provider Demographics
NPI:1295976884
Name:SHIPPEE FAMILY EYE CARE, P.C.
Entity type:Organization
Organization Name:SHIPPEE FAMILY EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SHIPPEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:603-788-3561
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:603-788-3561
Mailing Address - Fax:603-788-5549
Practice Address - Street 1:150 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NH
Practice Address - Zip Code:03584-3033
Practice Address - Country:US
Practice Address - Phone:603-788-3561
Practice Address - Fax:603-788-5549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0768152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30357369Medicaid
VT1016148Medicaid
VT1016148Medicaid
NH30357369Medicaid