Healthcare Provider Details

I. General information

NPI: 1285771956
Provider Name (Legal Business Name): RUTH LIPSON O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11996 VENTURA BLVD SUITE B
STUDIO CITY CA
91604-2606
US

IV. Provider business mailing address

25590 PRADO DE ORO
CALABASAS CA
91302
US

V. Phone/Fax

Practice location:
  • Phone: 818-763-1875
  • Fax: 818-505-0165
Mailing address:
  • Phone: 818-222-9850
  • Fax: 818-222-9850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number8913T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: