Provider Demographics
NPI:1841531977
Name:RIPLEY EYE CARE, LLC
Entity type:Organization
Organization Name:RIPLEY EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:STREET
Authorized Official - Last Name:CHILDERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-512-0019
Mailing Address - Street 1:1010B CITY AVE N
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38663-1413
Mailing Address - Country:US
Mailing Address - Phone:662-512-0019
Mailing Address - Fax:662-512-0430
Practice Address - Street 1:1010B CITY AVE N
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-1413
Practice Address - Country:US
Practice Address - Phone:662-512-0019
Practice Address - Fax:662-512-0430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS855152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS304441Medicare PIN