Provider Demographics
NPI:1194737007
Name:STIPEK, GREG ALLEN (OD)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:ALLEN
Last Name:STIPEK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7420 E PINNACLE PEAK RD
Mailing Address - Street 2:SUITE 122
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3625
Mailing Address - Country:US
Mailing Address - Phone:480-473-0079
Mailing Address - Fax:480-473-3357
Practice Address - Street 1:7420 E PINNACLE PEAK RD
Practice Address - Street 2:SUITE 122
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-3625
Practice Address - Country:US
Practice Address - Phone:480-473-0079
Practice Address - Fax:480-473-3357
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ820152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU36760Medicare UPIN
AZZ20077Medicare ID - Type Unspecified