Active NPI
Jesse Deon Whipple, OD
- Optometrist
- Mesa, AZ
National Provider Identifier
1639148588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 253
- Practice address
- 1356 S Gilbert Rd
#3
Mesa, AZ 85204 - Phone
- (480) 545-8985
- Fax
- (480) 545-9384
- NPI assigned
- Mar 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 253 | AZ | Primary |
Addresses
Primary practice location
1356 S Gilbert Rd
#3
Mesa, AZ 85204
Mailing address
1356 S Gilbert Rd
#3
Mesa, AZ 85204-6077
Phone (480) 545-8985
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 253 | AZ | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317081600000",
"number": "1639148588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1356 S GILBERT RD",
"address_2": "#3",
"city": "MESA",
"state": "AZ",
"postal_code": "852046077",
"telephone_number": "480-545-8985",
"fax_number": "480-545-9384"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1356 S GILBERT RD",
"address_2": "#3",
"city": "MESA",
"state": "AZ",
"postal_code": "85204",
"telephone_number": "480-545-8985",
"fax_number": "480-545-9384"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHIPPLE",
"first_name": "JESSE",
"middle_name": "DEON",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-14",
"last_updated": "2011-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "AZ",
"license": "253",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.