# GREGORY KIPP O.D.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336411891
- **Authorized official:** DR. GREGORY T. KIPP O.D. (OWNER)
- **Authorized official phone:** (386) 673-4220

## Contact information

- **Practice address:** 3710 SAINT JOHNS AVE, PALATKA, FL 32177-4026
- **Practice address phone:** (386) 328-1562
- **Mailing address:** 1206 OAK FOREST DR, ORMOND BEACH, FL 32174-4022
- **Mailing address phone:** (386) 673-4220

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 1387 | FL | Yes |

## Other

- **Enumeration date:** 01/30/2012
- **Last updated:** 01/30/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 078133900 | — | FL |