Provider Demographics
NPI:1639130321
Name:PIWONI-LIPPA, KARILYN M (OD)
Entity Type:Individual
Prefix:
First Name:KARILYN
Middle Name:M
Last Name:PIWONI-LIPPA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KARILYN
Other - Middle Name:M
Other - Last Name:PIWONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:601 ELMWOOD AVE BOX 888
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-3937
Mailing Address - Fax:
Practice Address - Street 1:160 OFFICE PKWY
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1759
Practice Address - Country:US
Practice Address - Phone:585-273-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006473152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC9375Medicare ID - Type Unspecified
U60704Medicare UPIN