Provider Demographics
NPI:1609397397
Name:LIPE, NATHAN (OD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
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 1:4052 E VAN BUREN STE B
Mailing Address - Street 2:
Mailing Address - City:EUREKA SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72632-9328
Mailing Address - Country:US
Mailing Address - Phone:479-253-7136
Mailing Address - Fax:479-253-9479
Practice Address - Street 1:4052 E VAN BUREN STE B
Practice Address - Street 2:
Practice Address - City:EUREKA SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72632-9328
Practice Address - Country:US
Practice Address - Phone:479-253-7136
Practice Address - Fax:479-253-9479
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2761152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist