=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821300336
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MATTHEW LIPPAS MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2010
-----------------------------------------------------
Last Update Date | 10/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8144 WALNUT HILL LN 448
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-4388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-369-3433
-----------------------------------------------------
Fax | 214-369-0636
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8144 WALNUT HILL LN 448
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-4388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-369-3433
-----------------------------------------------------
Fax | 214-369-0636
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPHTHALMOLOGY
-----------------------------------------------------
Name | DR. MATTHEW LIPPAS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 214-369-3433
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | G6740
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------