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General NPI Number Information
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NPI Number | 1043586118
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Entity Type | Organization
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Legal Business Name | RICHARD C LIPOVAC OD PC
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Dates
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Enumeration Date | 03/22/2012
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Last Update Date | 03/22/2012
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Provider Practice Location Address
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Address Line | 2717 HIGHWAY 54
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1031
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Country | US
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Telephone | 770-632-6422
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Fax | 770-632-6413
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Provider Business Mailing Address
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Address Line | 2717 HIGHWAY 54
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1031
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL OFFICER
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Name | RICHARD CHARLES LIPOVAC
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Credential |
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Telephone | 404-668-2290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1449T
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License Number State | GA
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