Provider Demographics
NPI:1609053115
Name:LIPE, HERMAN (OD)
Entity Type:Individual
Prefix:
First Name:HERMAN
Middle Name:
Last Name:LIPE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5909 E 47TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6846
Mailing Address - Country:US
Mailing Address - Phone:918-455-2020
Mailing Address - Fax:918-455-4030
Practice Address - Street 1:4008 S ELM PL
Practice Address - Street 2:SUITE A
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-2021
Practice Address - Country:US
Practice Address - Phone:918-455-2020
Practice Address - Fax:918-455-4030
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK619152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist