Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0801X | Contact Lens Fitter | C004055-1 | NY |
Y | 156FX1800X | Optician | C004055-1 | NY |
NPI | 1497994073 |
---|---|
Provider Name | Mr. Richard P. Rippa |
First Address | Lagrangeville, NY 12540-5027 |
Second Address | Lagrangeville, NY 12540-5027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2009 |
Last Update Date | 05/02/2009 |