Provider Demographics
NPI:1508845025
Name:SHIPPEE, SAMUEL PATRICK (OD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:PATRICK
Last Name:SHIPPEE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-3254
Mailing Address - Country:US
Mailing Address - Phone:802-223-7723
Mailing Address - Fax:802-223-6313
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
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030.000331152W00000X
NH0768152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1016148Medicaid
NH30357369Medicaid
NH30353009Medicaid
NH30357369Medicaid
NHRE776601Medicare PIN