Provider Demographics
NPI:1447391792
Name:LIPTON, CAROL (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:LIPTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9160 E SHOWCASE LN
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749
Mailing Address - Country:US
Mailing Address - Phone:520-495-4122
Mailing Address - Fax:
Practice Address - Street 1:4545 N ORACLE RD
Practice Address - Street 2:# 101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705
Practice Address - Country:US
Practice Address - Phone:520-888-6955
Practice Address - Fax:520-888-0354
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1435152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1435OtherAZ BOARD OF OPTOMETRY