Provider Demographics
NPI:1730698010
Name:TIPTON, STEPHEN THOMAS (OD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:THOMAS
Last Name:TIPTON
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 1:115 CYPRESS CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-7300
Mailing Address - Country:US
Mailing Address - Phone:417-631-3071
Mailing Address - Fax:
Practice Address - Street 1:1605 REILLY RD
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28307-5001
Practice Address - Country:US
Practice Address - Phone:417-631-3071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist