DR. JACK OWENS SIPPERLEY (NPI# 1235130402) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235130402 |
| Entity Type | Individual |
| Full Name | DR. JACK OWENS SIPPERLEY |
| Credential | MD |
| Practice Address |
4800 N 22nd St Phoenix AZ 85016-4701 |
| Practice Telephone | 6029551000 |
| Practice Fax Number | 6025084830 |
| Mailing Telephone | 6029551000 |
| Mailing Fax Number | 6025084830 |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2019-05-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207W00000X | Ophthalmology | 16167 | AZ | Allopathic & Osteopathic Physicians |
| Y | 207WX0107X |
Ophthalmology Specialization: Retina Specialist |
16167 | AZ | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 285412 | 05 |
| Street Address |
4800 N 22ND ST |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85016-4701 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679120968 | Evelyn Valenzuela | Technician/Technologist | 4800 N 22nd St, Phoenix, AZ 85016-4701 | 2019-08-21 |
| 1437588282 | Integrated Anesthesia Services, LLC | Nurse Anesthetist, Certified Registered | 4800 N 22nd St, Phoenix, AZ 85016-4701 | 2013-11-02 |
| 1063852259 | Joshua Perkins | Optometrist | 4800 N 22nd St, Phoenix, AZ 85016-4701 | 2013-07-02 |
| 1447690607 | Alison Domenica Kitzerow | Optometrist | 4800 N 22nd St, Phoenix, AZ 85016-4701 | 2013-07-02 |
| 1477897668 | Ophthalmic Anesthesia Services, Inc | Nurse Anesthetist, Certified Registered | 4800 N 22nd St, Phoenix, AZ 85016-4701 | 2012-11-12 |
| 1710239751 | Grant Harris Moore | Ophthalmology | 4800 N 22nd St, Phoenix, AZ 85016-4701 | 2012-10-14 |
| 1477814739 | Mahmood El-gasim | Ophthalmology | 4800 N 22nd St, Phoenix, AZ 85016-4701 | 2012-06-04 |
| 1538432844 | Barnet Dulaney Perkins Eye Center II Pllc | Clinic/Center | 4800 N 22nd St, Phoenix, AZ 85016-4701 | 2012-02-16 |
| 1659641462 | Integrated Eye Care Network | Health Maintenance Organization | 4800 N 22nd St, Phoenix, AZ 85016-4701 | 2012-01-10 |
| 1245510379 | Kacey Jane Gilford | Optometrist | 4800 N 22nd St, Phoenix, AZ 85016-4701 | 2011-08-21 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851992705 | Heatheranne Baker-oldfield | Counselor | 2415 E Camelback Rd Ste 700, Phoenix, AZ 85016 | 2020-11-06 |
| 1780215681 | Sip Home Systems - Mesa LLC | Home Health | 24th At Camelback, 2375 E. Camelback Rd., Suite 600, Phoenix, AZ 85016 | 2020-01-29 |
| 1760945588 | Wei Wei | Student in an Organized Health Care Education/Training Program | Phoenix Children's Hospital 1919 E. Thomas Rd., Phoenix, AZ 85016 | 2019-04-09 |
| 1942765623 | Grace Hatfield | Dietitian, Registered | Phoenix Childrens Hospital 1919 E Thomas Rd, Phoenix, AZ 85016 | 2019-02-06 |
| 1861977027 | Dawn Yvette Lima | Occupational Therapy Assistant | 3128 E Cheery Ln, Phoenix, AZ 85016 | 2018-10-03 |
| 1720583685 | Kristin Pauline Hicklin | Registered Nurse | 2930 E Camelback Rd Ste 100, Phoenix, AZ 85016 | 2018-03-24 |
| 1588181622 | Taness Eyre Billington | Pharmacist | 1625 E. Camelback Rd., Phoenix, AZ 85016 | 2017-08-29 |
| 1093239048 | Emma Ross | Psychologist | 1919 E Thomas Rd Bldg 4th, Phoenix, AZ 85016 | 2017-08-01 |
| 1609396985 | Mohammed Waseemuddin | Student in an Organized Health Care Education/Training Program | Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016 | 2017-06-27 |
| 1144777632 | Amanda Mazerall | Occupational Therapist | 4333 N 24th Street, Apartment 223, Phoenix, AZ 85016 | 2016-09-01 |
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| Taxonomy Code | 207WX0107X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| Specialization | Retina Specialist |
| An ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases. |
| Notes: Source: American Society of Retina Specialists, www.asrs.org [1/1/2017: new] - Additional Resources: American Academy of Ophthalmology, www.aao.org. Macula Society, www.maculasociety.org. Retina Society, www.retinasociety.org. Association of University Professors of Ophthalmology, www.aupo.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255759981 | Reda Issa | Ophthalmology | 1750 E Glendale Ave, Phoenix, AZ 85020 | 2014-03-31 |
| 1336576982 | Yousef J Cruz-inigo | Ophthalmology | 1750 E Glendale Ave, Phoenix, AZ 85020-5505 | 2013-09-27 |
| 1013353804 | Rima Bharat Patel | Ophthalmology | 1750 E Glendale Ave, Phoenix, AZ 85020-4328 | 2013-05-20 |
| 1205192697 | Kendra Klein-mascia | Ophthalmology | 1750 E Glendale Ave, Phoenix, AZ 85020-5505 | 2012-04-10 |
| 1164633160 | Associated Retina Consultants, Ltd. | Ophthalmology | 1750 E Glendale Ave, Phoenix, AZ 85020-5505 | 2007-05-24 |
| 1033257746 | Henry Mark Kwong Jr. | Ophthalmology | 1750 E Glendale Ave, Phoenix, AZ 85020-5505 | 2007-02-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003952318 | Mark Kim Walsh | Ophthalmology | 6561 E. Carondelet Dr., Tucson, AZ 85710-2161 | 2007-01-30 |
| 1821046251 | George S. Novalis | Ophthalmology | 6585 N Oracle Rd, Tucson, AZ 85704-5611 | 2006-05-05 |
| 1477532497 | Martin A Worrall | Ophthalmology | 1951 N Wilmot Rd Ste 15, Tucson, AZ 85712-8000 | 2006-01-10 |
| 1437615010 | Carrot Eye Center, Pllc | Ophthalmology | 1500 S Dobson Rd Ste 313, Mesa, AZ 85202-4752 | 2019-02-19 |
| 1760983563 | Global Retina Institute LLC | Ophthalmology | 4835 E Cactus Rd Ste 105, Scottsdale, AZ 85254 | 2018-02-27 |
| 1386084119 | William T. K. Stevenson | Ophthalmology | 6561 E Carondelet Dr, Tucson, AZ 85710 | 2013-06-25 |
| 1922234798 | Ryan K Wong | Ophthalmology | 6585 N. Oracle Rd, Tucson, AZ 85704-5611 | 2009-06-05 |
| 1407916992 | Rasw, PC | Ophthalmology | 6561 E Carondelet Dr, Tucson, AZ 85710-2156 | 2006-12-12 |
| 1518925858 | Egbert Saavedra | Ophthalmology | 6561 E Carondelet Dr, Tucson, AZ 85710-2156 | 2006-05-03 |
| 1740259142 | Diego H. Calonje M.d. PC | Ophthalmology | 1951 N Wilmot Rd, Suite 15, Tucson, AZ 85712-8000 | 2006-03-16 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.