Provider Demographics
NPI:1184673824
Name:LIPINSKI-DELBALSO, LEANE E (OD)
Entity Type:Individual
Prefix:
First Name:LEANE
Middle Name:E
Last Name:LIPINSKI-DELBALSO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LEANE
Other - Middle Name:
Other - Last Name:LIPINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2150 WILKES BARRE TOWNSHIP MARKET PL
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6059
Mailing Address - Country:US
Mailing Address - Phone:570-822-2568
Mailing Address - Fax:
Practice Address - Street 1:2150 WILKES BARRE TOWNSHIP MARKET PL
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6059
Practice Address - Country:US
Practice Address - Phone:570-822-2568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0EG001181152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102734Medicare PIN