Healthcare Provider Details

I. General information

NPI: 1942269576
Provider Name (Legal Business Name): JENNIFER R LIPPENS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 MONTAGUE AVE
GREENWOOD SC
29649-1440
US

IV. Provider business mailing address

PO BOX 1206
GREENWOOD SC
29648-1206
US

V. Phone/Fax

Practice location:
  • Phone: 864-229-2301
  • Fax: 864-229-1898
Mailing address:
  • Phone: 864-229-2301
  • Fax: 864-229-1898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberSC1280
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: