Provider Demographics
NPI:1154520666
Name:GIPP, JENNIFER E (OD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:GIPP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:E
Other - Last Name:WEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1830 STATE HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-7301
Mailing Address - Country:US
Mailing Address - Phone:563-382-2525
Mailing Address - Fax:
Practice Address - Street 1:1686 VIKING HILLS RD
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-7486
Practice Address - Country:US
Practice Address - Phone:563-382-2639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3121152W00000X
MN3102152W00000X
CA15007152W00000X
FLTPOP126152W00000X
VA0618003208152W00000X
MDTA2901152W00000X
AZOPT-002685152W00000X
IA002455152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2567OtherEYEMED VISION NO.