1023096849 NPI number — DR. CANDACE E LIPSHY OD

Table of content: DR. CANDACE E LIPSHY OD (NPI 1023096849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023096849 NPI number — DR. CANDACE E LIPSHY OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIPSHY
Provider First Name:
CANDACE
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALPAR
Provider Other First Name:
CANDACE
Provider Other Middle Name:
LIPSHY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1023096849
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5311 W 9TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79106-4161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-359-3937
Provider Business Mailing Address Fax Number:
806-359-8124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5311 W 9TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106-4161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-359-3937
Provider Business Practice Location Address Fax Number:
806-359-8124
Provider Enumeration Date:
01/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3717TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X , with the licence number: 3717TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 410022972 . This is a "TEXAS RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 20117426 . This is a "TEXAS DPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0192254 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3717TG . This is a "OPTOMETRIC LICENSE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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